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Przybilla B, Aberer W, Bircher AJ, Brehler R, Brockow K, Dickel H, Fuchs T, Hertl M, Mockenhaupt M, Pfaar O, Ring J, Sachs B, Vieluf D, Wedi B, Worm M, Zuberbier T, Merk HF. Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel. J Dtsch Dermatol Ges 2008. [DOI: 10.1111/j.1610-0387.2007.06656_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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77
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Przybilla B, Aberer W, Bircher AJ, Brehler R, Brockow K, Dickel H, Fuchs T, Hertl M, Mockenhaupt M, Pfaar O, Ring J, Sachs B, Vieluf D, Wedi B, Worm M, Zuberbier T, Merk HF. Allergological approach to drug hypersensitivity reactions. J Dtsch Dermatol Ges 2008; 6:240-3. [PMID: 18205837 DOI: 10.1111/j.1610-0387.2007.06656.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Przybilla B, Aberer W, Bircher AJ, Brehler R, Brockow K, Dickel H, Fuchs T, Hertl M, Mockenhaupt M, Pfaar O, Ring J, Sachs B, Vieluf D, Wedi B, Worm M, Zuberbier T, Merk HF. Allergologische Diagnostik von Überempfindlichkeitsreaktionen auf Arzneimittel. ALLERGO JOURNAL 2008. [DOI: 10.1007/bf03361737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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79
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Bircher AJ, Arnold A, Bach S, Häusermann P. Symmetrical Drug-Related Intertriginous and Flexural Exanthema – Reply. Dermatology 2008. [DOI: 10.1159/000111522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Scherer K, Grize L, Schindler C, Surber C, Bircher AJ. Reaction pattern to histamine and codeine in a human intradermal skin test model. Clin Exp Allergy 2007; 37:39-46. [PMID: 17210040 DOI: 10.1111/j.1365-2222.2006.02596.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin prick and intradermal skin tests (IDT) are useful tools in evaluating IgE-mediated allergic disorders. In the literature, many variations of the techniques used are described. No general agreement exists on test procedures and reading of test results. OBJECTIVE To analyse test conditions for IDT to facilitate comparability between different study protocols. METHODS We tested 24 healthy volunteers with three concentrations of histamine and codeine each on the upper back, lateral upper arm and volar forearm, with/without addition of ethylene diamine tetra-acetic acid. Reading of the resulting weal was performed by taking a digital image of the weal, later outlining the weal perimeter in triplicate and calculating the weal area using the NIH Image J software version 1.3. RESULTS Weal size was dose dependent for both substances, generally larger on the upper back than on the forearm and upper arm, and larger after codeine than after histamine. Addition of the Ca2+ -chelator ethylene diamine tetra-acetic acid did not significantly affect weal size. Weal size induced by histamine showed better consistency than that induced by codeine. CONCLUSIONS The results and our technique provide valuable tools for the daily routine as well as for the ability to compare information of intradermal tests from different studies or clinical reports. When assessing skin reactivity, we recommend the use of 1 mg/mL codeine as well as 0.1 mg/mL histamine to reflect aspects of mast-cell releasability and of vascular reactivity. The involvement of local factors influencing the vascular reactivity or differences in opiate receptor density on mast cells surfaces needs to be addressed in future studies.
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Gilgen-Anner Y, Heim M, Ledermann HP, Bircher AJ. Iodide mumps after contrast media imaging: a rare adverse effect to iodine. Ann Allergy Asthma Immunol 2007; 99:93-8. [PMID: 17650837 DOI: 10.1016/s1081-1206(10)60628-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Exposure to iodinated contrast media may elicit a variety of adverse reactions. Anaphylactoid and delayed cell-mediated unwanted effects are common; rare adverse reactions include iodine-related sialadenopathy, iododerma, and acneiform eruptions. OBJECTIVES To describe the occurrence of iodide mumps in a patient examined using contrast-enhanced computed tomography and to outline differential diagnoses. METHODS A detailed diagnostic approach, including histologic analysis, skin tests, controlled reexposure, efficacy of premedication, and imaging studies, is presented. The findings unique to this reaction and differential diagnoses are highlighted. RESULTS While undergoing repeated contrast-enhanced computed tomography a patient developed recurrent swellings of the sublingual glands, identified as iodide mumps. These swellings resolved within a few days. Imaging studies and histologic analysis showed distinct patterns without inflammation. The important role of iodine in this adverse reaction is demonstrated. CONCLUSIONS Iodine from iodinated contrast media may rarely elicit noninflammatory edema of the salivary glands. The reaction should be differentiated from other swellings in the head and neck area.
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Lerch M, Keller M, Britschgi M, Kanny G, Tache V, Schmid DA, Beeler A, Gerber BO, Luethi M, Bircher AJ, Christiansen C, Pichler WJ. Cross-reactivity patterns of T cells specific for iodinated contrast media. J Allergy Clin Immunol 2007; 119:1529-36. [PMID: 17412404 DOI: 10.1016/j.jaci.2007.02.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 02/09/2007] [Accepted: 02/09/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Approximately 3% of patients exposed to iodinated contrast media develop delayed hypersensitivity reactions. OBJECTIVE We wanted to better understand the molecular basis of contrast media cross-reactivity. METHODS Cross-reactivity was assessed by skin testing and measurement of T-cell activation (CD69 upregulation) and proliferation ((3)H-thymidine uptake, 5,6-carboxyfluorescein diacetate succinimidyl ester staining) of PBMCs, T-cell lines, and T-cell clones of 2 patients with delayed hypersensitivity reactions to iohexol and iomeprol, respectively. Thirteen different contrast media and potassium iodide were compared. RESULTS Skin testing and analyses of PBMCs, T-cell lines, and clones showed broad cross-reactivity in both patients. Broad as well as more restricted cross-reactivity patterns were found in iohexol-specific and iomeprol-specific CD4(+) T-cell clones, whereas 1 iomeprol-specific CD8(+) T-cell clone showed no cross-reactivity at all. The reactivity to equimolar concentrations of iohexol and its dimer iodixanol was very similar, suggesting that the dimer was not more stimulatory than its monomer. Consistently low reactivity to iobitridol was found in both patients, but never to iodide. A frequency analysis of contrast medium-specific peripheral T cells gave values between 0.6 % (iomeprol) and 0.05 % (iobitridol). CONCLUSION Clinically observed cross-reactivity between different contrast media is a result of the presence of contrast media-specific T cells, some of which show a broad cross-reactivity pattern. Iodide ions, known to be present at low concentration in contrast media solutions, do not seem to be the causative moiety. CLINICAL IMPLICATIONS Detailed in vitro analysis might help identify noncross-reactive contrast media.
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Abstract
Respiratory problems or urticaria are well known in patients sensitized to tobacco. This occurs mainly as an occupational disease in tobacco workers, but also occasionally in those who smoke tobacco or dip snuff. Similar respiratory problems and anaphylactoid reactions have been observed in patients sensitized to cannabis. This may occur in those allergic to cannabis pollen when the plants bloom, in those with agricultural exposure and rarely in the end consumer. We describe a patient with generalized itching provoked by tobacco and cannabis smoking. Skin prick tests and specific IgE towards tobacco and cannabis were positive. Because of the close correlation of smoking tobacco or cannabis and the onset of symptoms, we put forward the diagnosis of a type I allergic reaction towards tobacco and cannabis.
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Schwarzenbach Stöckli S, Bircher AJ. Generalisierter Pruritus sine materia bei Sensibilisierung gegenüber Tabak und Cannabis. J Dtsch Dermatol Ges 2007. [DOI: 10.1111/j.1610-0387.2007.06270_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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85
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Hausermann P, Bircher AJ. SDRIFE – Another Acronym for a Distinct Cutaneous Drug Exanthema: Do We Really Need It? Dermatology 2006; 214:1-2. [PMID: 17191038 DOI: 10.1159/000096903] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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86
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Arnold AW, Hausermann P, Bach S, Bircher AJ. Recurrent Flexural Exanthema (SDRIFE or Baboon Syndrome) after Administration of Two Different Iodinated Radio Contrast Media. Dermatology 2006; 214:89-93. [PMID: 17191055 DOI: 10.1159/000096920] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 03/27/2006] [Indexed: 12/31/2022] Open
Abstract
In 1984, the baboon syndrome was described as a particular form of systemic contact dermatitis that occurred after the administration of a contact allergen in individuals previously sensitized by topical exposure to the same allergen. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This specific reaction was originally observed with mercury, nickel and ampicillin. Since then over 100 cases have been described, most of them without known prior sensitization to the causative agent. In 2004, our group proposed the acronym SDRIFE specifically for cases associated with systemic drugs; it stands for symmetrical drug-related intertriginous and flexural exanthema, as a distinct reaction pattern related to systemic drugs. Here we describe a case of SDRIFE after administration of the iodinated radio contrast medium (RCM) iomeprol (Iomeron), accidentally reproduced by the RCM iopromide (Ultravist). Positive delayed skin tests with both drugs were observed indicating that the pathomechanism of SDRIFE is likely a cell-mediated type IV allergy. Oral potassium iodide and a skin-test-negative RCM were administered and both tolerated, indicating that the antigen is related to the molecules and not to iodine itself. Therefore, in our case skin tests had a good positive and negative predictive value.
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Bircher AJ, Harr T, Hohenstein L, Tsakiris DA. Hypersensitivity reactions to anticoagulant drugs: diagnosis and management options. Allergy 2006; 61:1432-40. [PMID: 17073874 DOI: 10.1111/j.1398-9995.2006.01227.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anticoagulants, including heparins, coumarins, hirudins, and some of the previously used plasma volume expanders, belong to the most widely used drugs. Hypersensitivity reactions from these agents are uncommon. However, they may have a considerable impact on patient safety and treatment decisions. Therefore, early diagnosis of potentially life-threatening adverse events and identification of alternatives is clinically important. This review contains an update on current knowledge about hypersensitivity reactions caused by the different anticoagulants. In addition, it discusses pathophysiologic mechanisms, diagnostic possibilities, and management options. The most common hypersensitivity reactions are erythematous plaques, occurring with a delay after subcutaneous application of heparins. Seldom they turn into maculopapular exanthema. Other hypersensitivity reactions are rare but may be life-threatening, e.g. skin necrosis because of heparin-induced thrombocytopenia. Skin and provocation tests with immediate and late readings are the most reliable diagnostic tools for heparin- or hirudin-induced urticaria/anaphylaxis or heparin-induced delayed plaques. If necrosis from heparins or coumarins is suspected, skin tests are contraindicated. In anaphylactic reactions caused by dextrans or hydroxyethyl starch skin tests are useless. Most in vitro tests have a low sensitivity and are not generally available. Therefore, in some anticoagulant-associated hypersensitivity reactions detailed allergologic investigation may help to identify safe treatment alternatives. However, several tests may be needed, and the procedures are usually time-consuming.
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89
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Imboden M, Nicod L, Nieters A, Glaus E, Matyas G, Bircher AJ, Ackermann-Liebrich U, Berger W, Probst-Hensch NM. The common G-allele of interleukin-18 single-nucleotide polymorphism is a genetic risk factor for atopic asthma. The SAPALDIA Cohort Study. Clin Exp Allergy 2006; 36:211-8. [PMID: 16433859 DOI: 10.1111/j.1365-2222.2006.02424.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND IL-18 is a pleiotrophic cytokine involved in both, T-helper type 1 (Th1) and Th2 differentiation. Recently genetic variants in the IL-18 gene have been associated with increased risk of atopy and asthma. OBJECTIVE To examine the relationship of a genetic, haplotype-tagging promotor variant -137G/C in the IL-18 gene with atopic asthma in a large, well-characterized and population-based study of adults. METHODS Prospective cohort study design was used to collect interview and biological measurement data at two examination time-points 11 years apart. Multivariate logistic regression analysis was used to assess the association of genotype with asthma and atopy. RESULTS The G-allele of the IL-18 promotor variant (-137G/C) was associated with a markedly increased risk for the prevalence of physician-diagnosed asthma with concomitant skin reactivity to common allergens. Stratification of the asthma cases by skin reactivity to common allergens revealed an exclusive association of IL-18 -137 G-allele with an increased prevalence of atopic asthma (adjusted odds ratio (OR): 3.63; 95% confidence interval: (1.64-8.02) for GC or GG carriers vs. CC carriers), and no according association with asthma and concomitant negative skin reactivity (adjusted OR: 1.13; 0.66-1.94). The interaction between IL-18 -137G/C genotype and positive skin prick test was statistically significant (P=0.029). None of 74 incident asthma cases with atopy at baseline exhibited the CC genotype. CONCLUSION Our results strongly suggest that this variant of the IL-18 gene is an important genetic determinant involved in the development of atopic asthma.
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Imboden M, Nieters A, Bircher AJ, Brutsche M, Becker N, Wjst M, Ackermann-Liebrich U, Berger W, Probst-Hensch NM. Cytokine gene polymorphisms and atopic disease in two European cohorts. (ECRHS-Basel and SAPALDIA). Clin Mol Allergy 2006; 4:9. [PMID: 16759385 PMCID: PMC1538621 DOI: 10.1186/1476-7961-4-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Accepted: 06/07/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atopy and allergic phenotypes are biologically characterized by an imbalanced T helper cell response skewed towards a type 2 (TH2) immune response associated with elevated serum immunoglobulin E (IgE) levels. Polymorphisms in cytokine genes might modulate regulation of the TH1/TH2 balance. We thus aimed at reproducing our previous findings from a European study population on the association of various cytokine polymorphisms with self-reported hay fever as well as increased total and specific IgE levels in two comparable study populations. METHODS Two prospective Caucasian cohorts were used. In the Basel center of the European Community Respiratory Health Survey (ECRHS, n = 418) ten distinct cytokine polymorphisms of putative functional relevance were genotyped. In the Swiss cohort Study on Air Pollution And Lung Disease In Adults (SAPALDIA, n = 6003) two cytokine polymorphisms were genotyped. The associations of these polymorphisms with atopy were estimated by covariance and logistic regression analysis. RESULTS We confirmed IL4, IL10, IL6 and IL18 as candidate genes for atopic health outcomes. In the large, well-characterized SAPALDIA cohort the IL6(-174G>C) and IL18(-137G>C) polymorphisms were associated with circulating total IgE concentrations in subjects with hay fever. The IL18(-137G>C) polymorphism was also associated with the prevalence of hay fever. CONCLUSION Comprehensive characterization of genetic variation in extended cytokine candidate gene regions is now needed. Large study networks must follow to investigate the association of risk patterns defined by genetic predisposing and environmental risk factors with specific atopic phenotypes.
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Harr T, Scherer K, Tsakiris DA, Bircher AJ. Immediate type hypersensitivity to low molecular weight heparins and tolerance of unfractioned heparin and fondaparinux. Allergy 2006; 61:787-8. [PMID: 16677252 DOI: 10.1111/j.1398-9995.2006.01063.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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92
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Scherer K, Studer W, Figueiredo V, Bircher AJ. Anaphylaxis to isosulfan blue and cross-reactivity to patent blue V: case report and review of the nomenclature of vital blue dyes. Ann Allergy Asthma Immunol 2006; 96:497-500. [PMID: 16597088 DOI: 10.1016/s1081-1206(10)60921-0] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Blue dyes used for lymphatic mapping in sentinel lymph node biopsy cause intraoperative anaphylactic reactions in up to 2.7% of patients. With increasing implementation of this technique, the incidence of anaphylaxis to these dyes can be expected to increase. In the literature, the chemically often unrelated and inconsistently designated dyes have been confused, adding to other inconsistencies in the nomenclature. OBJECTIVE To demonstrate the nomenclature, chemical and physiologic differences, and allergenicity of the various blue dyes used in a medical context. METHODS We describe a patient with an intraoperative grade IV anaphylactic reaction to isosulfan blue. Immediate-type hypersensitivity was proved by positive skin test reactions and CD63 expression to isosulfan blue and cross-reactivity to patent blue V. RESULTS A review of the literature clarified the exact nomenclature of the blue dyes and the possible pitfalls of confusing nomenclature in the context of structurally closely related dyes with different allergenic properties. For the detection of type I hypersensitivity, intracutaneous tests are valuable tools. An IgE-mediated mechanism has been shown recently. In most cases, sensitization exists without known previous exposure in a medical context. This may be due to the widespread use of such dyes in objects of everyday life. Preoperative antiallergic medication use does not prevent anaphylactic reactions but apparently reduces their severity. CONCLUSION For better comparison and precision, the Chemical Abstracts Service number of the respective dye should always be given.
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Buergin S, Scherer K, Häusermann P, Bircher AJ. Immediate Hypersensitivity to Rifampicin in 3 Patients: Diagnostic Procedures and Induction of Clinical Tolerance. Int Arch Allergy Immunol 2006; 140:20-6. [PMID: 16514245 DOI: 10.1159/000091839] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 12/29/2005] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Desensitization with drugs may be indicated in some clinical situations. Apart from large experiences with beta-lactam antibiotics and cotrimoxazole in HIV infection, experience with other drugs is limited. Rifampicin may elicit exanthema and urticaria, and their pathomechanisms are not known in detail. Since therapy with rifampicin may be indispensable in mycobacterial infections or against multiresistant Staphylococcus aureus, desensitization may be indicated in some patients. OBJECTIVE Report of immediate hypersensitivity to rifampicin and description of diagnostic and desensitization procedures. METHODS We report 3 patients with immediate urticarial reactions to rifampicin. Diagnostic procedures included skin and in vitro tests (specific IgE, lymphocyte transformation test, LTT, and CAST). The non-irritant cutoff concentration was evaluated in 24 volunteers. A 7-day desensitization procedure was used. RESULTS Only intradermal tests at a dilution of at least 1:10,000 (concentration of rifampicin approximately 0.006 mg/ml) were true positive, whereas in vitro tests (IgE, LTT and CAST) did not correctly identify hypersensitive patients. Two patients had positive accidental reexposure. All patients were successfully desensitized with rifampicin according to a slow 7-day protocol. CONCLUSIONS Rifampicin rarely elicits immediate hypersensitivity symptoms which may be diagnosed by intradermal skin tests. In vitro tests did not contribute to the diagnosis. Therefore, an IgE-mediated mechanism remains to be proven. Desensitization with rifampicin using different protocols has been reported. In our 3 cases, clinical tolerance to rifampicin was achieved using a 7-day protocol.
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Hausermann P, Scherer K, Weber M, Bircher AJ. Ciprofloxacin-induced acute generalized exanthematous pustulosis mimicking bullous drug eruption confirmed by a positive patch test. Dermatology 2006; 211:277-80. [PMID: 16205075 DOI: 10.1159/000087024] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2004] [Accepted: 12/20/2004] [Indexed: 11/19/2022] Open
Abstract
We report the case of an 80-year-old woman presenting with ciprofloxacin-induced acute generalized exanthematous pustulosis (AGEP) confirmed by a positive patch test. Cutaneous morphology, course and histological findings were consistent with a definite diagnosis according to the AGEP validation score of the EuroSCAR study group. We point to the rarity of quinolone-induced AGEP and discuss immunological mechanisms, the value of in vivo and in vitro tests as well as the main differential diagnosis. Furthermore, we highlight in this particular case the challenging differentiation from bullous drug eruption.
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Uter W, Hegewald J, Aberer W, Ayala F, Bircher AJ, Brasch J, Coenraads PJ, Schuttelaar MLA, Elsner P, Fartasch M, Mahler V, Belloni Fortina A, Frosch PJ, Fuchs T, Johansen JD, Menné T, Jolanki R, Krêcisz B, Kiec-Swierczynska M, Larese F, Orton D, Peserico A, Rantanen T, Schnuch A. The European standard series in 9 European countries, 2002/2003 - First results of the European Surveillance System on Contact Allergies. Contact Dermatitis 2005; 53:136-45. [PMID: 16128752 DOI: 10.1111/j.0105-1873.2005.00673.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.
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Uter W, Hegewald J, Aberer W, Ayala F, Bircher AJ, Brasch J, Coenraads PJ, Schuttelaar MLA, Elsner P, Fartasch M, Mahler V, Belloni Fortina A, Frosch PJ, Fuchs T, Johansen JD, Menné T, Jolanki R, Krêcisz B, Kiec-Swierczynska M, Larese F, Orton D, Peserico A, Rantanen T, Schnuch A. The European standard series in 9 European countries, 2002/2003 -- first results of the European Surveillance System on Contact Allergies. Contact Dermatitis 2005. [PMID: 16128752 DOI: 10.1111/j.0105‐1873.2005.00673.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Since January 2001, the European Surveillance System on Contact Allergies (ESSCA), supported by European Union funding (contract QLK4-CT-2001-00343), has started to collect patch-test data. This comprises a standardized clinical history and the patch-test results using the European standard series, from 17 centres in 9 European countries listed above. In 2002 and 2003, 10 511 patients' test results have been pooled and analysed. The anamnestic data partly reflect the subspecialties of some centres. The most common allergen was nickel sulfate (17.3%); however, large international variations were observed. The prevalence of contact allergy to Myroxylon pereirae resin (balsam of Peru) (5.8%) is coming close to the frequency found with the fragrance mix (6.4%). Regarding contact allergy to chromium compounds, different frequencies were noted in the 2 centres focused on occupational dermatitis (2.3% in the FIOH versus 7.4% in the Nofer Institute). These most likely reflect the beneficial effect of addition of ferrous sulfate in one, but not the other country. As differences may partly be due to different patch-test reading, standardization may need to be refined further. By providing post-marketing surveillance in the field of contact allergy, ESSCA will meet its objective of increased consumer safety across Europe.
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Langewitz W, Izakovic J, Wyler J, Schindler C, Kiss A, Bircher AJ. Effect of self-hypnosis on hay fever symptoms - a randomised controlled intervention study. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:165-72. [PMID: 15832067 DOI: 10.1159/000084001] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many people suffer from hay fever symptoms. Hypnosis has proved to be a useful adjunct in the treatment of conditions where allergic phenomena have an important role. METHODS Randomised parallel group study over an observation period of two consecutive pollen seasons. Outcome data include nasal flow under hypnosis, pollinosis symptoms from diaries and retrospective assessments, restrictions in well-being and use of anti-allergic medication. We investigated 79 patients with a mean age of 34 years (range 19-54 years; 41 males), with moderate to severe allergic rhinitis to grass or birch pollen of at least 2 years duration and mild allergic asthma. The intervention consisted of teaching self-hypnosis during a mean of 2.4 sessions (SD 1.7; range 2-5 sessions) and continuation of standard anti-allergic pharmacological treatment. RESULTS Of 79 randomised patients, 66 completed one, and 52 completed two seasons. Retrospective VAS scores yielded significant improvements in year 1 in patients who had learned self-hypnosis: pollinosis symptoms -29.2 (VAS score, range 0-100; SD 25.4; p < 0.001), restriction of well-being -26.2 (VAS score, range 0-100; SD 28.7; p < 0.001. In year 2, the control group improved significantly having learned self-hypnosis as well: pollinosis symptoms -24.8 (SD 29.1; p < 0.001), restriction of well-being -23.7 (SD 30.0; p < 0.001). Daily self-reports of subjects who learnt self-hypnosis do not show a significant improvement. The hazard ratio of reaching a critical flow of 70% in nasal provocation tests was 0.333 (95% CI 0.157-0.741) after having learnt and applied self-hypnosis.
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Bach S, Bircher AJ. Drug hypersensitivity reactions: from clinical manifestations to an allergologic diagnosis. Eur Ann Allergy Clin Immunol 2005; 37:213-8. [PMID: 16156399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Abstract
Most of the encounters with biting and stinging insects result in more or less pronounced localized reactions. Typically, urticarial wheals and papular reactions are observed. Less often local bullous or hemorrhagic or disseminated papular reactions, particularly in children and immunologically naive adults, may be seen. With the exception of bee and wasp venom allergies, immediate-type allergic reactions to arthropod stings and bites are rare. Systemic IgE-mediated hypersensitivity has also been reported from additional hymenoptera species, e.g. hornets, bumble bees and ants. Rare are systemic reactions to mosquitoes, flies or kissing bugs and exceptional from ticks, bed bugs, moths, caterpillars and spiders. A major problem is the often lacking standardization of extracts for skin testing and for the determination of specific IgE. Some of the allergens have been characterized and few of them synthesized using recombinant techniques. Most investigations have been made with whole-body extracts or extracts from salivary glands, while desensitization has rarely been attempted. Currently, primary prevention by avoidance of stings and bites, and adequate instruction of sensitized individuals in the use of emergency drugs are mandatory.
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100
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Abstract
Early and rapid recognition of severe adverse drug reactions is essential. Prompt withdrawal of the offending drug is the most important action to minimize morbidity and mortality. Dependent on the type of reaction, e.g. in immediate type reactions instant withdrawal and therapy are mandatory, whereas in delayed reactions diagnosis as early as possible may be life-saving. The skin is an important herald organ and may early signal a severe evolution of a cutaneous reaction or involvement of circulating blood cells or internal organs. A synthesis considering all factors should be made to obtain an early and correct diagnosis.
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