text:
Stephanie Cole
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Stephanie Cole
OBE
Cole filming Doc Martin in Port Isaac, June 2009
Born
Patricia Stephanie Cole
(1941-10-05) 5 October 1941 (age 76)
Solihull, Warwickshire, England
Occupation
Actress
Years active
1968–present
Spouse(s)
Henry Marshall (m. 1973–86; divorced)
Peter Birrel (m. 1998–2004; his death)
Children
Emma Battcock
Patricia Stephanie Cole, OBE (born 5 October 1941)[1] is an English stage, television, radio and film actress, known for high-profile television roles in shows such as Tenko (1981–85), Open All Hours (1982–85), A Bit of a Do (1989), Waiting for God (1990–94), Keeping Mum (1997–98), Doc Martin (2004–09), Still Open All Hours (2013–present) Man Down (2014-present) and as Sylvia Goodwin in ITV soap opera Coronation Street (2011–13).
She won Best TV Actress at the 1992 British Comedy Awards for her role in Waiting For God and won Best Comedy Performance at the 2012 British Soap Awards for her role in Coronation Street. She was made an OBE in the 2005 Queen's Birthday Honours.
Contents
[hide]
1 Early life
2 Career
2.1 Stage
2.2 Radio
2.3 Other
3 Honours
4 Personal life
5 TV and filmography
6 Award wins
7 References
8 External links
Early life[edit]
Cole was born in Solihull, Warwickshire, and trained at the Bristol Old Vic Theatre School from 1958 to 1960 and went on to consolidate her acting skills in repertory theatres around the United Kingdom. She made her stage debut at the age of seventeen playing the eccentric, elderly medium Madame Arcati in Noël Coward's Blithe Spirit. At the age of 63 she returned to the same role when the play was revived at the West End's Savoy Theatre in 2004.
Career[edit]
One of Cole's most recognised and popular roles was of Dr Beatrice Mason in the 1980s television series Tenko, a drama which chronicled the lives of British women in Singapore after the Japanese invasion and their consequent confinement in a Japanese prisoner of war camp. The series was explicit in its portrayal of the horrific conditions and brutality faced by the women during their imprisonment, and dealt with issues such as rape, stillbirth, lesbianism, suicide, abortion and euthanasia. Cole played the role of the stern, officious yet kindly doctor over three series and a one-off special between 1981 and 1985.
During this same period, Cole also played the elderly, paranoid and morose customer Mrs Delphine Featherstone, nicknamed "The Black Widow", in the BBC comedy Open All Hours. Mrs Featherstone was the only rival to Nurse Gladys Emmanuel for the affections of shopkeeper Arkwright, played by Ronnie Barker (who had recommended her to play the part after seeing her in Tenko), although she was attracted to him only because she liked his stingy ways. Arkwright was scared of her advances and often hid when he saw her approaching the shop. Cole was actually only in her early forties when she took the role; playing characters much older than she actually is (notably in Waiting for God) became a hallmark of her career.
In 1988, Cole joined actresses Thora Hird, Maggie Smith, Julie Walters and Patricia Routledge in the award-winning first series of Talking Heads, featuring dramatic monologues written for BBC Television by British playwright Alan Bennett. Cole performed the role of Muriel to great acclaim during the half-hour monologue "Soldiering On". In later years, Cole would repeat her performance of this now famous monologue on both the London stage and for BBC Radio.
Another of Cole's famous roles was of bad-tempered retired photojournalist Diana Trent in the sitcom Waiting for God, which ran from 1990 to 1994. Although Diana was supposed to be a pensioner, Cole was actually 48 years old when she took the role, for which she received the 1992 Best TV Comedy Actress award at the British Comedy Awards.
From 2004 to 2009, Cole starred with Martin Clunes and Caroline Catz in the ITV comedy-drama, Doc Martin as Joan Norton, aunt of Clunes's character Dr Martin Ellingham. In 2006, Cole starred with Victoria Wood in the BAFTA award-winning World War II drama Housewife, 49 as Mrs Waite, the local head of what was then the WVS. Cole also had a small role in the 2008 romantic comedy Miss Pettigrew Lives for a Day as Miss Pettigrew's grumpy boss, Miss Holt.
In April 2011, Cole joined the cast of Coronation Street, playing Sylvia Goodwin, the mother of regular character Roy Cropper. In August 2012, she was cast in an adaptation of the 1938 thriller film The Lady Vanishes on the BBC.[2]
In August 2013, it was announced that Cole had left Coronation Street, just episodes after her onscreen daughter-in-law had been diagnosed with pancreatic cancer.[3] It was initially speculated that her sudden departure was due to illness but Cole later confirmed on Twitter that her already pending departure had been brought forward due to her brother's death.[4]
Since 2013, Cole has reprised her role as Delphine Featherstone in Still Open All Hours. She stars with original actors David Jason, Lynda Baron and Maggie Ollerenshaw.[5]
Stage[edit]
Cole has also performed as a stage actress for more than fifty years. On the West End stage, she has featured in The Mousetrap in 1968 (Ambassadors Theatre) as Miss Casewell, Noises Off in 1983 (Savoy Theatre), Steel Magnolias in 1989 (Lyric Theatre) and Quartet in 1999 (Albery Theatre). Her most prominent stage role was as Betty in the hit comedy A Passionate Woman written by Kay Mellor. The play, directed by Ned Sherrin, opened at the Comedy Theatre in 1994 and had a nine-month extended run. On the West End's production's last curtain call, Cole was made the subject of This Is Your Life.[citation needed]
Radio[edit]
Cole has appeared in several radio series. She starred in the BBC Radio 4 comedy, Ed Reardon's Week as Olive, a student in Ed's writing class. Other work for BBC Radio 4 includes the role of Carolyn Knapp-Shappey, opposite Benedict Cumberbatch and Roger Allam in the successful airline sitcom Cabin Pressure.[6] In 2017 Cole also starred in an episode of "John Finnemore's Double Acts" on Radio 4.
Other[edit]
In 1998, Cole's career in comedy was commemorated in the BBC documentary series Funny Women.[7] In the same year, Cole's autobiography A Passionate Life was published. The book's foreword was written by British theatre director Ned Sherrin.
Honours[edit]
In 2002, Cole was awarded an honorary Masters of Arts degree from the University of Bristol.[8] In 2005, she was made an Officer of the Order of the British Empire (OBE) in the Queen's Birthday Honours List for her services to drama, the elderly and mental health charities.
Cole was voted Solihull's favourite Silhillian in a competition run by Solihull Council in December 2006. She beat Lucy Davis, Martin Johnson and Richard Hammond to pick up the top crown in The S Factor.[9]
Personal life[edit]
In 1973, Cole married fight director Henry Marshall, who was one of the founders of the British Academy of Dramatic Combat and was a Master at Arms at the Royal Academy of Dramatic Art.[10] They have a daughter, Emma Battcock (born 1973). They divorced in 1988. In 1998, Cole married fellow actor Peter Birrel after meeting him again, thirty years after they first appeared together in a production of Richard II at the Bristol Old Vic.
TV and filmography[edit]
Year
Title
Role
Notes
Reference
1978 International Velvet Teacher
1978 Lillie Agnes Langtry Episode title: America!
1979 That Summer! Mrs. Mainwaring
1981–1985 Tenko Dr. Beatrice Mason
1982–1985 Open All Hours Mrs. Delphine Featherstone
1986–1988 Return of the Antelope Sarah Mincing
1988 Talking Heads Muriel Episode title: Soldiering On
1989 A Bit of a Do Betty Sillitoe
1990–1994 Waiting for God Diana Trent
1991 Agatha Christie's Poirot Mrs. Lacey Episode title: The Theft of the Royal Ruby
1997–1998 Keeping Mum Mrs. Bear
1999 Grey Owl Ada Belaney
2001 Life As We Know It Lizzie Cameron
2004–2009 Doc Martin Joan Norton
2008 Miss Pettigrew Lives for a Day Miss Holt
2011–2013 Coronation Street Sylvia Goodwin [11]
2013–present Still Open All Hours Mrs. Delphine Featherstone
2013 The Lady Vanishes Evelyn Floodporter
2014–present Man Down Nesta
Award wins[edit]
1992 British Comedy Awards – Best TV Comedy Actress for Waiting for God
2012 British Soap Awards – Best Comedy Performance for Coronation Street[12]
References[edit]
Jump up ^ "Stephanie Cole". IMDb. Retrieved 31 January 2015.
Jump up ^ "BBC to revamp Hitchcock thriller 'The Lady Vanishes'". BBC News. 17 August 2012. Retrieved 31 January 2015.
Jump up ^ Kilkelly, Daniel (2 August 2013). "'Coronation Street': Stephanie Cole leaves Sylvia Goodwin role". Digital Spy. Retrieved 31 January 2015.
Jump up ^ Brown, David (14 October 2013). "Coronation Street: Stephanie Cole was originally intended to have a large role in Hayley exit plot". Radio Times. Retrieved 31 January 2015.
Jump up ^ "'Still Open all Hours' Cast". IMDb. Retrieved 15 January 2016.
Jump up ^ She also played opposite Hugh Bonneville in the Sci-fi comedy "Married". "Cabin Pressure". BBC Radio 4. Retrieved 31 January 2015.
Jump up ^ "Funny Women". IMDb. Retrieved 31 January 2015.
Jump up ^ "Stephanie Cole Archive". Bristol University. Retrieved 17 December 2017.
Jump up ^ Reynolds, Leda (16 May 2008). "Actress Stephanie Cole returns to hometown of Solihull". Birmingham Mail. Retrieved 25 June 2009.
Jump up ^ "History". British Academy of Dramatic Combat. Archived from the original on 9 May 2008.
Jump up ^ "Stephanie Cole to join Coronation Street cast". BBC News. 17 December 2010. Retrieved 17 December 2017.
Jump up ^ Taylor, Jim (29 April 2012). "EastEnders wins top prize at British Soap Awards". BBC Newsbeat. Retrieved 17 December 2017.
External links[edit]
Stephanie Cole on IMDb
"Stephanie Cole". Aveleyman.
Thomas, Nick (3 October 2016). "Tinseltown Talks: One of Britain's finest: Stephanie Cole". USA Today. Retrieved 4 October 2016.
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text:
Anaphylaxis
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Anaphylaxis
Angioedema of the face such that the boy cannot open his eyes. This reaction was caused by an allergen exposure.
Specialty
Allergy and immunology
Symptoms
Itchy rash, throat swelling, shortness of breath, lightheadedness[1]
Usual onset
Over minutes to hours[1]
Causes
Insect bites, foods, medications[1]
Diagnostic method
Based on symptoms[2]
Similar conditions
Allergic reaction, angioedema, asthma exacerbation, carcinoid syndrome[2]
Treatment
Epinephrine, intravenous fluids[1]
Frequency
0.05–2%[3]
[edit on Wikidata]
Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death.[4][5] It typically causes more than one of the following: an itchy rash, throat or tongue swelling, shortness of breath, vomiting, lightheadedness, and low blood pressure.[1] These symptoms typically come on over minutes to hours.[1]
Common causes include insect bites and stings, foods, and medications.[1] Other causes include latex exposure and exercise.[1] Additionally cases may occur without an obvious reason.[1] The mechanism involves the release of mediators from certain types of white blood cells triggered by either immunologic or non-immunologic mechanisms.[6] Diagnosis is based on the presenting symptoms and signs after exposure to a potential allergen.[1]
The primary treatment of anaphylaxis is epinephrine injection into a muscle, intravenous fluids, and positioning the person flat.[1][7] Additional doses of epinephrine may be required.[1] Other measures, such as antihistamines and steroids, are complementary.[1] Carrying an epinephrine autoinjector and identification regarding the condition is recommended in people with a history of anaphylaxis.[1]
Worldwide, 0.05–2% of the population is estimated to experience anaphylaxis at some point in life.[3] Rates appear to be increasing.[3] It occurs most often in young people and females.[7][8] Of people who go to a hospital with anaphylaxis in the United States about 0.3% die.[9] The term comes from the Ancient Greek: ἀνά, translit. ana, lit. 'against', and the Ancient Greek: φύλαξις, translit. phylaxis, lit. 'protection'.[10]
Contents
[hide]
1 Signs and symptoms
1.1 Skin
1.2 Respiratory
1.3 Cardiovascular
1.4 Other
2 Causes
2.1 Food
2.2 Medication
2.3 Venom
2.4 Risk factors
3 Pathophysiology
3.1 Immunologic
3.2 Non-immunologic
4 Diagnosis
4.1 Classification
4.2 Allergy testing
4.3 Differential diagnosis
4.4 Post-mortem findings
5 Prevention
6 Management
6.1 Epinephrine
6.2 Adjuncts
6.3 Preparedness
7 Prognosis
8 Epidemiology
9 History
10 Research
11 References
12 External links
Signs and symptoms[edit]
Signs and symptoms of anaphylaxis.
Anaphylaxis typically presents many different symptoms over minutes or hours[7][11] with an average onset of 5 to 30 minutes if exposure is intravenous and 2 hours if from eating food.[12] The most common areas affected include: skin (80–90%), respiratory (70%), gastrointestinal (30–45%), heart and vasculature (10–45%), and central nervous system (10–15%)[13] with usually two or more being involved.[3]
Skin[edit]
Urticaria and flushing on the back of a person with anaphylaxis
Symptoms typically include generalized hives, itchiness, flushing, or swelling (angioedema) of the afflicted tissues.[4] Those with angioedema may describe a burning sensation of the skin rather than itchiness.[12] Swelling of the tongue or throat occurs in up to about 20% of cases.[14] Other features may include a runny nose and swelling of the conjunctiva.[15] The skin may also be blue tinged because of lack of oxygen.[15]
Respiratory[edit]
Respiratory symptoms and signs that may be present include shortness of breath, wheezes, or stridor.[4] The wheezing is typically caused by spasms of the bronchial muscles[16] while stridor is related to upper airway obstruction secondary to swelling.[15] Hoarseness, pain with swallowing, or a cough may also occur.[12]
Cardiovascular[edit]
Coronary artery spasm may occur with subsequent myocardial infarction, dysrhythmia, or cardiac arrest.[3][13] Those with underlying coronary disease are at greater risk of cardiac effects from anaphylaxis.[16] The coronary spasm is related to the presence of histamine-releasing cells in the heart.[16] While a fast heart rate caused by low blood pressure is more common,[15] a Bezold–Jarisch reflex has been described in 10% of cases where a slow heart rate is associated with low blood pressure.[8] A drop in blood pressure or shock (either distributive or cardiogenic) may cause the feeling of lightheadedness or loss of consciousness.[16] Rarely very low blood pressure may be the only sign of anaphylaxis.[14]
Other[edit]
Gastrointestinal symptoms may include crampy abdominal pain, diarrhea, and vomiting.[4] There may be confusion, a loss of bladder control or pelvic pain similar to that of uterine cramps.[4][15] Dilation of blood vessels around the brain may cause headaches.[12] A feeling of anxiety or of "impending doom" has also been described.[3]
Causes[edit]
Anaphylaxis can occur in response to almost any foreign substance.[17] Common triggers include venom from insect bites or stings, foods, and medication.[8][18] Foods are the most common trigger in children and young adults while medications and insect bites and stings are more common in older adults.[3] Less common causes include: physical factors, biological agents such as semen, latex, hormonal changes, food additives such as monosodium glutamate and food colors, and topical medications.[15] Physical factors such as exercise (known as exercise-induced anaphylaxis) or temperature (either hot or cold) may also act as triggers through their direct effects on mast cells.[3][19] Events caused by exercise are frequently associated with the ingestion of certain foods.[12] During anesthesia, neuromuscular blocking agents, antibiotics, and latex are the most common causes.[20] The cause remains unknown in 32–50% of cases, referred to as "idiopathic anaphylaxis."[21] Six vaccines (MMR, varicella, influenza, hepatitis B, tetanus, meningococcal) are recognized as a cause for anaphylaxis, and HPV may cause anaphylaxis as well.[22] Physical exercise is an uncommon cause of anaphylaxis;[23] in about a third of such cases there is a co-factor like taking an NSAID or eating a specific food prior to exercising.[24]
Food[edit]
Many foods can trigger anaphylaxis; this may occur upon the first known ingestion.[8] Common triggering foods vary around the world. In Western cultures, ingestion of or exposure to peanuts, wheat, nuts, certain types of seafood like shellfish, milk, and eggs are the most prevalent causes.[3][13] Sesame is common in the Middle East, while rice and chickpeas are frequently encountered as sources of anaphylaxis in Asia.[3] Severe cases are usually caused by ingesting the allergen,[8] but some people experience a severe reaction upon contact. Children can outgrow their allergies. By age 16, 80% of children with anaphylaxis to milk or eggs and 20% who experience isolated anaphylaxis to peanuts can tolerate these foods.[17]
Medication[edit]
Any medication may potentially trigger anaphylaxis. The most common are β-lactam antibiotics (such as penicillin) followed by aspirin and NSAIDs.[13][25] Other antibiotics are implicated less frequently, and the reactions to NSAIDs are agent specific meaning that those who are allergic to one NSAID can typically tolerate a different one.[25] Other relatively common causes include chemotherapy, vaccines, protamine and herbal preparations.[3] Some medications (vancomycin, morphine, x-ray contrast among others) cause anaphylaxis by directly triggering mast cell degranulation.[8]
The frequency of a reaction to an agent partly depends on the frequency of its use and partly on its intrinsic properties.[26] Anaphylaxis to penicillin or cephalosporins occurs only after it binds to proteins inside the body with some agents binding more easily than others.[12] Anaphylaxis to penicillin occurs once in every 2,000 to 10,000 courses of treatment, with death occurring in fewer than one in every 50,000 courses of treatment.[12] Anaphylaxis to aspirin and NSAIDs occurs in about one in every 50,000 persons.[12] If someone has a reaction to penicillins, his or her risk of a reaction to cephalosporins is greater but still less than one in 1,000.[12] The old radiocontrast agents caused reactions in 1% of cases, while the newer lower osmolar agents cause reactions in 0.04% of cases.[26]
Venom[edit]
Venom from stinging or biting insects such as Hymenoptera (ants, bees, and wasps) or Triatominae (kissing bugs) may cause anaphylaxis in susceptible people.[7][27][28] Previous systemic reactions, which are anything more than a local reaction around the site of the sting, are a risk factor for future anaphylaxis;[29][30] however, half of fatalities have had no previous systemic reaction.[31]
Risk factors[edit]
People with atopic diseases such as asthma, eczema, or allergic rhinitis are at high risk of anaphylaxis from food, latex, and radiocontrast agents but not from injectable medications or stings.[3][8] One study in children found that 60% had a history of previous atopic diseases, and of children who die from anaphylaxis, more than 90% have asthma.[8] Those with mastocytosis or of a higher socioeconomic status are at increased risk.[3][8] The longer the time since the last exposure to the agent in question, the lower the risk.[12]
Pathophysiology[edit]
Anaphylaxis is a severe allergic reaction of rapid onset affecting many body systems.[5][6] It is due to the release of inflammatory mediators and cytokines from mast cells and basophils, typically due to an immunologic reaction but sometimes non-immunologic mechanism.[6]
Immunologic[edit]
In the immunologic mechanism, immunoglobulin E (IgE) binds to the antigen (the foreign material that provokes the allergic reaction). Antigen-bound IgE then activates FcεRI receptors on mast cells and basophils. This leads to the release of inflammatory mediators such as histamine. These mediators subsequently increase the contraction of bronchial smooth muscles, trigger vasodilation, increase the leakage of fluid from blood vessels, and cause heart muscle depression.[6][12] There is also an immunologic mechanism that does not rely on IgE, but it is not known if this occurs in humans.[6]
Non-immunologic[edit]
Non-immunologic mechanisms involve substances that directly cause the degranulation of mast cells and basophils. These include agents such as contrast medium, opioids, temperature (hot or cold), and vibration.[6][19] Sulfites may cause reactions by both immunologic and non-immunologic mechanisms.[32]
Diagnosis[edit]
Anaphylaxis is diagnosed on the basis of a person's signs and symptoms.[3] When any one of the following three occurs within minutes or hours of exposure to an allergen there is a high likelihood of anaphylaxis:[3]
Involvement of the skin or mucosal tissue plus either respiratory difficulty or a low blood pressure causing symptoms
Two or more of the following symptoms after a likely contact with an allergen:
a. Involvement of the skin or mucosa
b. Respiratory difficulties
c. Low blood pressure
d. Gastrointestinal symptoms
Low blood pressure after exposure to a known allergen
Skin involvement may include: hives, itchiness or a swollen tongue among others. Respiratory difficulties may include: shortness of breath, stridor, or low oxygen levels among others. Low blood pressure is defined as a greater than 30% decrease from a person's usual blood pressure. In adults a systolic blood pressure of less than 90 mmHg is often used.[3]
During an attack, blood tests for tryptase or histamine (released from mast cells) might be useful in diagnosing anaphylaxis due to insect stings or medications. However these tests are of limited use if the cause is food or if the person has a normal blood pressure,[3] and they are not specific for the diagnosis.[17]
Classification[edit]
There are three main classifications of anaphylaxis. Anaphylactic shock is associated with systemic vasodilation that causes low blood pressure which is by definition 30% lower than the person's baseline or below standard values.[14] Biphasic anaphylaxis is the recurrence of symptoms within 1–72 hours with no further exposure to the allergen.[3] Reports of incidence vary, with some studies claiming as many as 20% of cases.[33] The recurrence typically occurs within 8 hours.[8] It is managed in the same manner as anaphylaxis.[7] Pseudoanaphylaxis or anaphylactoid reactions are a type of anaphylaxis that does not involve an allergic reaction but is due to direct mast cell degranulation.[8][34] Non-immune anaphylaxis is the current term used by the World Allergy Organization[34] with some recommending that the old terminology no longer be used.[8]
Allergy testing[edit]
Skin allergy testing being carried out on the right arm
Patch test
Allergy testing may help in determining the trigger. Skin allergy testing is available for certain foods and venoms.[17] Blood testing for specific IgE can be useful to confirm milk, egg, peanut, tree nut and fish allergies.[17]
Skin testing is available to confirm penicillin allergies, but is not available for other medications.[17] Non-immune forms of anaphylaxis can only be determined by history or exposure to the allergen in question, and not by skin or blood testing.[34]
Differential diagnosis[edit]
It can sometimes be difficult to distinguish anaphylaxis from asthma, syncope, and panic attacks.[3] Asthma however typically does not entail itching or gastrointestinal symptoms, syncope presents with pallor rather than a rash, and a panic attack may have flushing but does not have hives.[3] Other conditions that may present similarly include: scrombroidosis and anisakiasis.[8]
Post-mortem findings[edit]
In a person who died from anaphylaxis, autopsy may show an "empty heart" attributed to reduced venous return from vasodilation and redistribution of intravascular volume from the central to the peripheral compartment.[35] Other signs are laryngeal edema, eosinophilia in lungs, heart and tissues, and evidence of myocardial hypoperfusion.[36] Laboratory findings could detect increased levels of serum tryptase, increase in total and specific IgE serum levels.[36]
Prevention[edit]
Avoidance of the trigger of anaphylaxis is recommended. In cases where this may not be possible, desensitization may be an option. Immunotherapy with Hymenoptera venoms is effective at desensitizing 80–90% of adults and 98% of children against allergies to bees, wasps, hornets, yellowjackets, and fire ants. Oral immunotherapy may be effective at desensitizing some people to certain food including milk, eggs, nuts and peanuts; however, adverse effects are common.[3] For example, many people develop an itchy throat, cough, or lip swelling during immunotherapy.[37] Desensitization is also possible for many medications, however it is advised that most people simply avoid the agent in question. In those who react to latex it may be important to avoid cross-reactive foods such as avocados, bananas, and potatoes among others.[3]
Management[edit]
Anaphylaxis is a medical emergency that may require resuscitation measures such as airway management, supplemental oxygen, large volumes of intravenous fluids, and close monitoring.[7] Administration of epinephrine is the treatment of choice with antihistamines and steroids (for example, dexamethasone) often used as adjuncts.[7] A period of in-hospital observation for between 2 and 24 hours is recommended for people once they have returned to normal due to concerns of biphasic anaphylaxis.[8][12][33][38]
Epinephrine[edit]
An old version of an EpiPen auto-injector
Epinephrine (adrenaline) is the primary treatment for anaphylaxis with no absolute contraindication to its use.[7] It is recommended that an epinephrine solution be given intramuscularly into the mid anterolateral thigh as soon as the diagnosis is suspected. The injection may be repeated every 5 to 15 minutes if there is insufficient response.[7] A second dose is needed in 16-35% of episodes with more than two doses rarely required.[7] The intramuscular route is preferred over subcutaneous administration because the latter may have delayed absorption.[7][39] Minor adverse effects from epinephrine include tremors, anxiety, headaches, and palpitations.[3]
People on β-blockers may be resistant to the effects of epinephrine.[8] In this situation if epinephrine is not effective intravenous glucagon can be administered which has a mechanism of action independent of β-receptors.[8]
If necessary, it can also be given intravenously using a dilute epinephrine solution. Intravenous epinephrine, however, has been associated both with dysrhythmia and myocardial infarction.[7] Epinephrine autoinjectors used for self-administration typically come in two doses, one for adults or children who weigh more than 25 kg and one for children who weigh 10 to 25 kg.[40]
Adjuncts[edit]
Antihistamines (both H1 and H2), while commonly used and assumed effective based on theoretical reasoning, are poorly supported by evidence.[41][42] A 2007 Cochrane review did not find any good-quality studies upon which to base recommendations[42] and they are not believed to have an effect on airway edema or spasm.[8] Corticosteroids are unlikely to make a difference in the current episode of anaphylaxis, but may be used in the hope of decreasing the risk of biphasic anaphylaxis. Their prophylactic effectiveness in these situations is uncertain.[33] Nebulized salbutamol may be effective for bronchospasm that does not resolve with epinephrine.[8] Methylene blue has been used in those not responsive to other measures due to its presumed effect of relaxing smooth muscle.[8]
Preparedness[edit]
People prone to anaphylaxis are advised to have an "allergy action plan." Parents are advised to inform schools of their children's allergies and what to do in case of an anaphylactic emergency. The action plan usually includes use of epinephrine autoinjectors, the recommendation to wear a medical alert bracelet, and counseling on avoidance of triggers.[43] Immunotherapy is available for certain triggers to prevent future episodes of anaphylaxis. A multi-year course of subcutaneous desensitization has been found effective against stinging insects, while oral desensitization is effective for many foods.[13]
Prognosis[edit]
In those in whom the cause is known and prompt treatment is available, the prognosis is good.[44] Even if the cause is unknown, if appropriate preventative medication is available, the prognosis is generally good.[12] If death occurs, it is usually due to either respiratory (typically asphyxia) or cardiovascular causes (shock),[6][8] with 0.7–20% of cases causing death.[12][16] There have been cases of death occurring within minutes.[3] Outcomes in those with exercise-induced anaphylaxis are typically good, with fewer and less severe episodes as people get older.[21]
Epidemiology[edit]
The number of people who get anaphylaxis is 4–100 per 100,000 persons per year,[8][45] with a lifetime risk of 0.05–2%.[46] About 30% of people get more than one attack.[45] Exercise-induced anaphylaxis affects about 1 in 2000 young people.[24]
Rates appear to be increasing: with the numbers in the 1980s being approximately 20 per 100,000 per year, while in the 1990s it was 50 per 100,000 per year.[13] The increase appears to be primarily for food-induced anaphylaxis.[47] The risk is greatest in young people and females.[7][8]
Anaphylaxis leads to as many as 500–1,000 deaths per year (2.7 per million) in the United States, 20 deaths per year in the United Kingdom (0.33 per million), and 15 deaths per year in Australia (0.64 per million).[8] Another estimate from the United States puts the death rate at 0.7 per million.[48] Mortality rates have decreased between the 1970s and 2000s.[49] In Australia, death from food-induced anaphylaxis occur primarily in women while deaths due to insect bites primarily occur in males.[8] Death from anaphylaxis is most commonly triggered by medications.[8]
History[edit]
The term aphylaxis was coined by Charles Richet in 1902 and later changed to anaphylaxis due to its nicer quality of speech.[17] In his experiments, Richet injected a dog with sea anemone (Actinia) toxin in an attempt to protect it. Although the dog had previously tolerated the toxin, on re-exposure, three weeks later with the same dose, it developed fatal anaphylaxis. Thus instead of inducing tolerance (prophylaxis), when lethal responses resulted from previously tolerated doses, he coined the word a (without) phylaxis (protection). He was subsequently awarded the Nobel Prize in Physiology or Medicine for his work on anaphylaxis in 1913.[12] The phenomenon itself, however, has been described since ancient times.[34] The term comes from the Greek words ἀνά, ana, "against", and φύλαξις, phylaxis, "protection".[50]
Research[edit]
There are ongoing efforts to develop sublingual epinephrine to treat anaphylaxis.[8] Subcutaneous injection of the anti-IgE antibody omalizumab is being studied as a method of preventing recurrence, but it is not yet recommended.[3][51]
References[edit]
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External links[edit]
Classification
V · T · D
ICD-10: T78.2
ICD-9-CM: 995.0
MeSH: D000707
DiseasesDB: 29153
External resources
MedlinePlus: 000844
eMedicine: med/128

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Anaphylaxis at DMOZ
National Institute for Health and Clinical Excellence. Clinical guideline 134: Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode. London, 2011. and Anaphylaxis pathway
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Rural Free Delivery
From Wikipedia, the free encyclopedia
Jump to: navigation, search
For the EP by Whiskeytown, see Rural Free Delivery (EP).
Rural Free Delivery (RFD) is a service which began in the United States in the late 19th century, to deliver mail directly to rural farm families. Prior to RFD, individuals living in more remote homesteads had to pick up mail themselves at sometimes distant post offices or pay private carriers for delivery. RFD became a political football, with politicians promising it to voters and using it themselves to reach voters. The proposal to offer free rural delivery was not universally embraced. Private carriers and local shopkeepers feared a loss of business. The United States Post Office Department began experiments with Rural Free Delivery as early as 1890. However, it was not until 1893, when Georgia Congressman Thomas E. Watson pushed through legislation, that the practice was mandated.[1] However, universal implementation was slow; RFD was not adopted generally in the United States Post Office until 1902.[2] The rural delivery service uses a network of rural routes traveled by carriers to deliver and pick up mail to and from roadside mailboxes.[3]
Rural Free Delivery vehicle (from Popular Mechanics, September 1905)
Contents
[hide]
1 History
2 First routes
3 See also
4 References
5 Further reading
6 External links
History[edit]
Rural carrier in an early electric vehicle, circa 1910
Until the late 19th century, residents of rural areas had to either travel to a distant post office to pick up their mail, or else pay for delivery by a private carrier. Postmaster General John Wanamaker, owner of a major department store, was ardently in favor of Rural Free Delivery (RFD), with many thousands of Americans living in rural communities who wanted to send and receive retail orders inexpensively. However, the adoption of a nationwide RFD system had many opponents. Some were simply opposed to the cost of the service. Private express carriers thought inexpensive rural mail delivery would eliminate their business, and many town merchants worried the service would reduce farm families' weekly visits to town to obtain goods and merchandise, or that mail order merchants selling through catalogs, such as Sears, Roebuck and Company might present significant competition.[1][4]
Support for the introduction of a nationwide rural mail delivery service came from The National Grange of the Order of Patrons of Husbandry, the nation's oldest agricultural organization.
Fayette County in east-central Indiana claims to be the birthplace of Rural Free Delivery. Milton Trusler, a leading farmer in the county, began advocating the idea in 1880; as the president of the Indiana Grange, he spoke to farmers statewide frequently over the following sixteen years.[5]
The Post Office Department first experimented with the idea of rural mail delivery on October 1, 1891 to determine the viability of RFD. They began with five routes covering ten miles, 33 years after free delivery in cities had begun. The first routes to receive RFD during its experimental phase were in Jefferson County, West Virginia, near Charles Town, Halltown, and Uvilla.[6]
Legislation by U.S. Congressman Thomas E. Watson of Georgia mandated the practice, and RFD finally became an official service in 1896.[1] That year, 82 rural routes were put into operation. A massive undertaking, nationwide RFD service took several years to implement, and remains the "biggest and most expensive endeavor"[7] ever instituted by the U.S. postal service.
The service has grown steadily. By 1901, the mileage had increased to over 100,000; the cost was $1,750,321 and over 37,000 carriers were employed. In 1910 the mileage was 993,068; cost $36,915,000; carriers 40,997. In 1913 came the introduction of parcel post delivery, which caused another boom in rural deliveries. Parcel post service allowed the distribution of national newspapers and magazines, and was responsible for millions of dollars of sales in mail-order merchandise to customers in rural areas. In 1930 there were 43,278 rural routes serving about 6,875,321 families—that is about 25,471,735 persons. The cost was $106,338,341.[8] In 1916, the Rural Post "Good" Roads Act authorized federal funds for rural post roads.
First routes[edit]
The following is a list of the first rural routes established in each state, along with the names of the (up to three) Post Offices served and the date of establishment.[6]
State
Post Office(s)
Date
Alabama Opelika December 7, 1896
Alaska Nome May 10, 1901
Arizona Tempe November 24, 1896
Arkansas Clarksville October 19, 1896
California Campbell February 1, 1897
Colorado Loveland November 10, 1896
Connecticut Branford, Guilford, Milford June 1, 1898
Delaware Harrington October 3, 1898
District of
Columbia Anacostia, Bennings September 1, 1902
Florida Winter Park January 1, 1898
Georgia Quitman December 8, 1896
Hawaii Haiku March 1, 1918
Idaho Moscow April 14, 1900
Illinois Auburn December 10, 1896
Indiana Hartsville, Hope October 15, 1896
Iowa Morning Sun November 10, 1896
Kansas Bonner Springs October 26, 1896
Kentucky Allensville January 11, 1897
Louisiana Thibodaux November 1, 1896
Maine Gorham, Naples, Sebago Lake November 23, 1896
Maryland Westminster October 15, 1896
Massachusetts Bernardston, Greenfield November 2, 1896
Michigan Climax December 3, 1896
Minnesota Farmington January 1, 1897
Mississippi Hickory October 1, 1901
Missouri Cairo October 15, 1896
Montana Billings February 1, 1902
Nebraska Tecumseh November 7, 1896
Nevada Lovelock December 1, 1903
New Hampshire Pittsfield October 20, 1898
New Jersey Moorestown June 6, 1898
New Mexico Roswell March 1, 1902
New York Elba October 15, 1896
North Carolina China Grove October 23, 1896
North Dakota Wahpeton October 3, 1898
Ohio Collinsville, Darrtown, Somerville October 15, 1896
Oklahoma Hennessey August 15, 1900
Oregon Turner October 16, 1897
Pennsylvania New Stanton, Ruffsdale November 24, 1896
Rhode Island South Portsmouth January 1, 1899
South Carolina Cope, Orangeburg, Saint George March 1, 1899
South Dakota Ellis May 1, 1899
Tennessee Atoka January 11, 1897
Texas Fate, La Grange August 1, 1899
Utah Murray August 15, 1899
Vermont Grand Isle December 21, 1896
Virginia Palmyra October 22, 1896
Washington North Yakima April 1, 1897
West Virginia Charles Town, Halltown, Uvilla October 1, 1896
Wisconsin Sun Prairie November 16, 1896
Wyoming Hilliard, Sheridan, Wheatland October 15, 1900
See also[edit]
U.S. Parcel Post stamps of 1912-13
Mayberry R.F.D.
References[edit]
^ Jump up to: a b c Encyclopædia Britannica - Rural Free Delivery
Jump up ^ Historian United States Postal Service (May 2007). "Rural Free Delivery" (PDF). United States Postal Service. Retrieved April 17, 2011. On October 1, 1890, Congress authorized funding of $10,000 to test the “practicability” of delivering mail to small towns, defined as those having populations of from 300 to 5,000 people, and nearby rural districts..
Jump up ^ "Rural Mailboxes". National Postal Museum. Retrieved 2008-11-07.
Jump up ^ Clark, Mary (Spring 2007). "Rural Free Delivery" (PDF). Dane County Historical Society Newsletter. Madison, WI 53711, US: Dane County Historical Society. 26 (1): 5–6. Archived (PDF) from the original on 2012-03-05. Retrieved 2015-05-15. Did You Know? 'Neither snow nor rain .....' Contrary to popular belief, the quote at the beginning of this article is not the official motto of the U.S. Postal Service. According to the Postal Service, this inscription was supplied by William Mitchell Kendall of the firm McKim, Mead & White, the architects who designed the New York General Post Office building in 1912. Kendall explained that the sentence appears in the works of Herodotus and describes the expedition of the Greeks against the Persians under Cyrus, about 500 B.C. The Persians operated a system of mounted postal couriers, and the sentence describes the fidelity with which their work was done.
Jump up ^ Division of Historic Preservation and Archeology. Fayette County Interim Report. Indianapolis: Indiana Department of Natural Resources, 1981-07, xviii.
^ Jump up to: a b "First Rural Routes by State". United States Postal Service. Retrieved 2013-12-28.
Jump up ^ Harry McKown (2006-10-31). "This Month in North Carolina History". This Month in North Carolina History. University of North Carolina.
Jump up ^ "Parcel Post: Delivery of Dreams". Smithsonian Institution Libraries.
Further reading[edit]
Barron, Hal S. mixed harvest: The second great transformation in the rural north, 1870-1930 (U of North Carolina Press, 1997).
Fuller, Wayne Edison. RFD, the changing face of rural America (1964), a standard scholarly history
Kernell, Samuel, and Michael P. McDonald. "Congress and America's political development: The transformation of the post office from patronage to service." American Journal of Political Science 43#3 (1999), pp. 792-811 in JSTOR; online copy
Perlman, Elisabeth Ruth, and Steven Sprick Schuster. "Delivering the Vote: The Political Effect of Free Mail Delivery in Early Twentieth Century America." Journal of Economic History 76.3 (2016): 769-802. online
External links[edit]
1903 film of carrier receiving RFD mail to deliver in Westminster, Maryland, from the Library of Congress
[show]
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Visit the main page

values:
/wiki/Special:Random
Load a random article [ctrl-alt-x]
x

values: portal navigation p-navigation p-navigation-label

values: Guidance on how to use and edit Wikipedia

values: About the project, what you can do, where to find things

values: A list of recent changes in the wiki [ctrl-alt-r]

values: portal navigation p-interaction p-interaction-label

values: List of all English Wikipedia pages containing links to this page [ctrl-alt-j]

values: Recent changes in pages linked from this page [ctrl-alt-k]

values:
/wiki/Wikipedia:File_Upload_Wizard
Upload files [ctrl-alt-u]
u

values: A list of all special pages [ctrl-alt-q]

values: Permanent link to this revision of the page

values: Link to connected data repository item [ctrl-alt-g]

values: Printable version of this page [ctrl-alt-p]

values: mediawiki ltr sitedir-ltr mw-hide-empty-elt ns-0 ns-subject page-Rural_Free_Delivery rootpage-Rural_Free_Delivery vector-nav-directionality skin-vector action-view