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Zhang J, Yang F, Wang M, Yang A, Zhang F, Xiao Y, Guan Y, Yu X. Fixed drug eruption-induced balanoposthitis: a case report. Int J Impot Res 2023:10.1038/s41443-023-00817-y. [PMID: 38145981 DOI: 10.1038/s41443-023-00817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/01/2023] [Accepted: 12/14/2023] [Indexed: 12/27/2023]
Abstract
Fixed Drug Eruptions (FDE) represent a distinctive type of adverse drug reaction, typically characterized by recurring, sharply demarcated skin lesions occurring at identical sites with each administration of the causative drug. A less frequent, albeit significant manifestation of FDE, is balanoposthitis, an inflammatory condition affecting the glans penis and prepuce. This rare case report explores the clinical presentation, diagnosis, and therapeutic management of FDE-induced balanoposthitis in a 34-year-old male patient who developed this condition following azithromycin administration to treat a pulmonary infection. The patient's distinctive symptoms, coupled with a medical history of similar antibiotic-induced reactions, pointed strongly towards an FDE diagnosis. Management entailed immediate discontinuation of the offending drug and initiation of symptomatic treatment, culminating in a positive therapeutic outcome. This case illuminates the potential of commonly prescribed medications, such as antibiotics, to incite balanoposthitis via FDE. It underscores the critical need for healthcare professionals to include FDE in their differential diagnosis for balanoposthitis, especially when patient exposure to high-risk medications is evident. Furthermore, the report emphasizes the pressing requirement for additional research to elucidate the pathogenesis of FDE-induced balanoposthitis and to devise effective therapeutic and preventive measures.
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Affiliation(s)
- Jingyi Zhang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Fang Yang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Meijing Wang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Aili Yang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Feng Zhang
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yao Xiao
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Yanxin Guan
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China
| | - Xujun Yu
- TCM Regulating Metabolic Diseases Key Laboratory of Sichuan Province, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, 610075, China.
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2
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Marietti R, Bianchi L, Hansel K, Casciola G, Biondi F, Tramontana M, Stingeni L. Multiple allergy to cephalosporins confirmed by patch test: From the first to the fifth generation. Contact Dermatitis 2023; 88:487-490. [PMID: 36855909 DOI: 10.1111/cod.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Rossella Marietti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Casciola
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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3
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Saff RR. Skin testing as a biomarker in drug allergy. Ann Allergy Asthma Immunol 2023; 130:161-168. [PMID: 36243283 DOI: 10.1016/j.anai.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022]
Abstract
Despite the significant negative impact drug allergies can have on patient care, the diagnosis is largely based on clinical history, and there are limited diagnostic tests that can be done at the time of a reaction. Biomarkers are needed to improve the diagnosis and the identification of the culprit medication. Skin testing is the most useful biomarker for immediate- and delayed-type reactions available, but it is limited by its low sensitivity. To improve its accuracy and reproducibility, a standardized procedure must be used. For immediate-type reactions, penicillin skin testing is the most widely studied, and it can be used in patients with history of anaphylaxis or recent immunoglobulin E-mediated reaction or for whom there is a significant risk if a reaction were to occur, such as pregnancy. Skin testing is also important in allergy to platinum agents allowing for continued first-line therapy. For delayed-type reactions, patch testing and delayed intradermal testing, used in conjunction with clinical history, can help to improve identification of the culprit medication depending on the type of reaction. Other biomarkers including in vitro testing for specific immunoglobulin E, basophil activation test, lymphocyte transformation test, ELISpot, and genetic factors that increase the likelihood of reaction are under investigation, and they may be most helpful when used in combination with the clinical history and skin testing results.
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Affiliation(s)
- Rebecca R Saff
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Teo YX, Friedmann PS, Polak ME, Ardern-Jones MR. Utility and Safety of Skin Tests in Drug Reaction With Eosinophilia and Systemic Symptoms (DRESS): A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:481-491.e5. [PMID: 36154897 DOI: 10.1016/j.jaip.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 08/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determination of culprit drug in drug reaction with eosinophilia and systemic symptoms (DRESS) is crucial. Skin tests have been used, although it remains unclear how sensitive these are. OBJECTIVE To determine the value of skin tests in the assessment of drug causality in DRESS. METHODS A systematic literature search was conducted for publications from 1996 onward of skin tests (skin prick test = SPT, patch test = PT, intradermal test = IDT) performed in clearly defined DRESS cases. Outcomes of testing, drug culpability assessments, and challenge test data were extracted. RESULTS A total of 17 articles met inclusion criteria. In 290 patients with DRESS, patch testing was most frequent (PT = 97.2% [n = 282], IDT = 12.4% [n = 36], SPT = 3.1% [n = 9]). Positive results were noted in 58.4% (n = 160 of 282) of PTs, 66.5% of IDTs, and 25% of SPTs. When confidence of drug causality was high (n = 73 of 194), testing did not correlate well with clinical suspicion: PTs, 37.6%; IDTs, 36.5%. Direct comparison of skin testing with provocation testing (n = 12) showed 83.3% correlation. Positive IDT results were reported in 8 negative PT cases. CONCLUSIONS Skin tests, particularly PTs and IDTs, have been reported as tools for diagnosis of causal drugs in DRESS. Heterogeneity in methodology, results analysis, and reporting of cohorts make meta-analysis to determine sensitivity and specificity of published literature impossible and highlight weaknesses in the field. We propose that international collaboration is essential to harmonize the methodology and reporting measures from hypersensitivity testing studies in larger cohorts.
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Affiliation(s)
- Ying Xin Teo
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Peter Simon Friedmann
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Marta Ewa Polak
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Michael Roger Ardern-Jones
- Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Department of Dermatology, Southampton General Hospital, University Hospitals Southampton NHS Foundation Trust, Southampton, United Kingdom.
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Manson LEN, Chan PCY, Böhringer S, Guchelaar HJ. Genotyping for HLA risk alleles versus patch tests to diagnose anti-seizure medication induced cutaneous adverse drug reactions. Front Pharmacol 2022; 13:1061419. [DOI: 10.3389/fphar.2022.1061419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 11/22/2022] Open
Abstract
Aim: To provide a comparison of genotyping for HLA risk alleles versus patch testing to determine which of these two tests is a better diagnostic tool for cutaneous hypersensitivity reactions caused by anti-seizure medication.Methods: A literature study was performed in PubMed to assess the sensitivity and specificity of HLA genotyping and patch tests for identifying anti-seizure medication induced cutaneous hypersensitivity reactions.Results: This study shows that HLA-B*15:02 genotyping shows high sensitivity for carbamazepine-induced SJS/TEN, especially in Han Chinese and Southeast Asian patients (66.7–100.0%) whereas the sensitivity of patch tests (0.0–62,5%), HLA-A*31:01 (0–50%) and HLA-B*15:11 (18.2–42.9%) are lower. On the contrary, for carbamazepine and phenytoin induced DRESS, patch tests (respectively 70.0–88.9% and 14.3–70.0%) show higher sensitivity than HLA tests (0–66.7% and 0–12.7%). Also for lamotrigine-induced DRESS patch tests perform better than HLA-B*15:02 (33.3–40.0 versus 0%). For anti-seizure medication induced MPE and for oxcarbazepine-induced SCARs more studies are needed.Conclusion: Use of HLA-B genotyping may aid clinicians in the diagnosis of carbamazepine, phenytoin, lamotrigine and oxcarbazepine induced SJS/TEN, particularly in Han Chinese and Southeast Asian patients. On the other hand, patch tests seem to perform better in the diagnosis of carbamazepine and phenytoin induced DRESS.
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Thaiwat S, Rojanapanthu P. Cutaneous adverse drug eruption: the role of drug patch testing. Int J Dermatol 2022; 62:108-114. [DOI: 10.1111/ijd.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/09/2022] [Accepted: 07/28/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Supitchaya Thaiwat
- Division of Dermatology Department of Internal Medicine Phramongkutkloa Hospital Bangkok Thailand
| | - Pattareewan Rojanapanthu
- Division of Dermatology Department of Internal Medicine Phramongkutkloa Hospital Bangkok Thailand
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7
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Woodruff CM, Botto N. The Role of Patch Testing in Evaluating Delayed Hypersensitivity Reactions to Medications. Clin Rev Allergy Immunol 2022; 62:548-561. [PMID: 35113364 PMCID: PMC9156465 DOI: 10.1007/s12016-022-08924-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 12/19/2022]
Abstract
Confirming drug imputability is an important step in the management of cutaneous adverse drug reactions (CADR). Re-challenge is inconvenient and in many cases life threatening. We review the literature on ideal patch testing technique for specific CADRs. Testing should be performed approximately 3 months after the resolution of the eruption using standard patch testing techniques. Commercially available patch test preparations are available for a minority of drugs, so in most cases, testing should be performed with the drug at various recommended concentrations and in different vehicles. Testing to all known excipients, such as dyes, vehicles and preservatives is also important. Immunosuppressive medications should be discontinued or down titrated to the lowest tolerable dose to decrease the risk of false negative reactions. We provide an overview of expert recommendations and extant evidence on the utility of patch testing for identifying the culprit drug in common CADRs and for specific drug or drug classes. Overall, there appears to be significant variability in the patch test positivity of different drugs, which is likely the result of factors intrinsic to the drug such as dermal absorption (as a function of lipophilicity and molecular size) and whether the drug itself or a downstream metabolite is implicated in the immune reaction. Drugs with high patch test positivity rates include beta-lactam antibiotics, aromatic anticonvulsants, phenytoin, and corticosteroids, among others. Patch testing positivity varies both as a function of the drug and type of CADR. The sum of the evidence suggests that patch testing in the setting of morbilliform eruptions, fixed drug eruption, acute generalized exanthematous pustulosis, and possibly also drug-induced hypersensitivity syndrome, photoallergic and eczematous reactions may be worthwhile, although utility of testing may vary on the specific drug in question for the eruption. It appears to be of limited utility and is not recommended in the setting of other complex CADR, such as SJS/TEN and leukocytoclastic vasculitis.
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Affiliation(s)
| | - Nina Botto
- University of California San Francisco, San Francisco, CA, USA
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8
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Patch Testing in Drug Eruptions: Practical Aspects and Literature Review of Eruptions and Culprit Drugs. Dermatitis 2022; 33:16-30. [PMID: 35029348 DOI: 10.1097/der.0000000000000839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT There is overwhelming evidence that many delayed cutaneous adverse drug reactions (beginning >6 hours after drug intake) are mediated by delayed-type (type IV) hypersensitivity, including maculopapular eruptions, erythroderma, symmetrical drug-related intertriginous and flexural exanthema/baboon syndrome, eczematous eruptions, fixed drug eruptions, acute generalized exanthematous pustulosis, and drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome. Therefore, after resolution of the reaction, patch tests should be performed as first diagnostic method to identify the culprit drug(s). This article provides tools to perform drug patch tests properly and safely, discussing clinical history, indications, procedure, drug patch test materials, sensitivity, the meaning of negative patch tests, and safety of the procedure. In addition, a literature review of eruptions and culprit drugs is provided in tabular format.
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9
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Goutham S, Pathave H, Dongre A, Gund G, Nayak C. A case series of generalized Lichenoid Drug Eruption due to Anti-Tubercular Drugs: Treated with immunosuppressant’s while continuing Anti-Tubercular therapy. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Bhujoo Z, Ingen-Housz-Oro S, Gener G, Gaudin O, Fleck M, Verlinde-Carvalho M, Paul M, Chosidow O, Wolkenstein P, Assier H. Patch tests in nonimmediate cutaneous adverse drug reactions: The importance of late readings on day 4. Contact Dermatitis 2021; 86:29-33. [PMID: 34590309 DOI: 10.1111/cod.13981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/02/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patch tests (PTs) with two readings have been used for decades to identify the culprit drug in nonimmediate cutaneous adverse drug reactions (NICADRs), followed more recently by late reading of intradermal tests (IDTs). Some teams tend to perform PTs with only one reading before IDTs or even directly perform IDTs. OBJECTIVES To evaluate the relevance of a late PT reading on day 4 (D4) in NICADRs. METHODS We retrospectively selected patients who had a PT for an NICADR between July 2014 and March 2020. RESULTS During the study period, 328 patients had a PT with available results. Among the 75 positive-PT patients with available data for the two readings, 41 (54.7%) had positive results on D2 and D4 and 34 (45.3%) had negative results on D2 but positive results on D4. No patient had positive results on D2 and negative results on D4. CONCLUSION This study shows that a D4 reading enhanced the PT-positive results. A positive PT result allows for reducing the number of IDTs, which are more difficult and costly to perform. Our series suggests that a late PT reading at D4 should be performed for exploring NICADRs.
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Affiliation(s)
- Zoé Bhujoo
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Gwendeline Gener
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Olivier Gaudin
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
| | - Margaux Fleck
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France
| | | | - Muriel Paul
- EA7379 EpidermE, Univ Paris Est Créteil EpidermE, Créteil, France.,Department of Pharmacy, AP-HP, Hôpital Henri-Mondor, Créteil, France
| | - Olivier Chosidow
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,University Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Paul Wolkenstein
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,University Paris Est Créteil Val de Marne UPEC, Créteil, France
| | - Haudrey Assier
- Dermatology Department, APHP, Henri Mondor Hospital, Créteil, France.,Reference Center for Toxic Bullous Diseases and Severe Drug Reactions, Créteil, France
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11
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Delabeling Delayed Drug Hypersensitivity: How Far Can You Safely Go? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:2878-2895.e6. [PMID: 33039012 DOI: 10.1016/j.jaip.2020.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
Delayed immune-mediated adverse drug reactions (IM-ADRs) are defined as reactions occurring more than 6 hours after dosing. They include heterogeneous clinical phenotypes that are typically T-cell-mediated reactions with distinct mechanisms across a wide spectrum of severity from benign exanthems through to life-threatening cutaneous or organ-specific diseases. For mild reactions such as benign exanthem, considerations for delabeling are similar to immediate reactions and may include a graded or single-dose drug challenge with or without preceding skin or patch testing. Evaluation of challenging cases such as the patient who is on multiple drugs at the time a severe delayed IM-ADR occurs should prioritize clinical ascertainment of the most likely phenotype and implicated drug(s). Although not widely available and validated, procedures such as patch testing, delayed intradermal skin testing, and laboratory-based functional drug assays or genetic (human leukocyte antigen) testing may provide valuable information to further help risk stratify patients and identify the likely implicated and/or cross-reactive drug(s). The decision to use a drug challenge as a diagnostic or delabeling tool in a patient with a severe delayed IM-ADR should weigh the risk-benefit ratio, balancing the severity and priority for the treatment of the underlying, and the availability of alternative efficacious and safe treatments.
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Broyles AD, Banerji A, Barmettler S, Biggs CM, Blumenthal K, Brennan PJ, Breslow RG, Brockow K, Buchheit KM, Cahill KN, Cernadas J, Chiriac AM, Crestani E, Demoly P, Dewachter P, Dilley M, Farmer JR, Foer D, Fried AJ, Garon SL, Giannetti MP, Hepner DL, Hong DI, Hsu JT, Kothari PH, Kyin T, Lax T, Lee MJ, Lee-Sarwar K, Liu A, Logsdon S, Louisias M, MacGinnitie A, Maciag M, Minnicozzi S, Norton AE, Otani IM, Park M, Patil S, Phillips EJ, Picard M, Platt CD, Rachid R, Rodriguez T, Romano A, Stone CA, Torres MJ, Verdú M, Wang AL, Wickner P, Wolfson AR, Wong JT, Yee C, Zhou J, Castells M. Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 8:S16-S116. [PMID: 33039007 DOI: 10.1016/j.jaip.2020.08.006] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Ana Dioun Broyles
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Sara Barmettler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Catherine M Biggs
- Department of Pediatrics, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Kimberly Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Patrick J Brennan
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Rebecca G Breslow
- Division of Sports Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen M Buchheit
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Katherine N Cahill
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Josefina Cernadas
- Allergology and Immunology Service, Centro Hospitalar Universitário de S.João Hospital, Porto, Portugal
| | - Anca Mirela Chiriac
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Elena Crestani
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Pascale Dewachter
- Department of Anesthesiology and Intensive Care Medicine, Groupe Hospitalier Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Meredith Dilley
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Jocelyn R Farmer
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Dinah Foer
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Ari J Fried
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Sarah L Garon
- Associated Allergists and Asthma Specialists, Chicago, Ill
| | - Matthew P Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - David L Hepner
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Mass
| | - David I Hong
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Joyce T Hsu
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Parul H Kothari
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Timothy Kyin
- Division of Asthma, Allergy & Immunology, University of Virginia, Charlottesville, Va
| | - Timothy Lax
- Division of Allergy and Inflammation, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Min Jung Lee
- Allergy and Immunology at Hoag Medical Group, Newport Beach, Calif
| | - Kathleen Lee-Sarwar
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Anne Liu
- Division of Allergy / Immunology, Stanford University School of Medicine, Palo Alto, Calif
| | - Stephanie Logsdon
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Andrew MacGinnitie
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Maciag
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Samantha Minnicozzi
- Division of Allergy and Clinical Immunology, Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Allison E Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep, Department of Medicine, University of California, San Francisco Medical Center, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | - Sarita Patil
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth J Phillips
- Department of Medicine & Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Division of Allergy and Clinical Immunology, Department of Medicine, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Québec, Canada
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Tito Rodriguez
- Drug Allergy Department, Al-Rashed Allergy Center, Sulaibikhat, Al-Kuwait, Kuwait
| | - Antonino Romano
- IRCCS Oasi Maria S.S., Troina, Italy & Fondazione Mediterranea G.B. Morgagni, Catania, Italy
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Maria Jose Torres
- Allergy Unit and Research Group, Hospital Regional Universitario de Málaga, UMA-IBIMA-BIONAND, ARADyAL, Málaga, Spain
| | - Miriam Verdú
- Allergy Unit, Hospital Universitario de Ceuta, Ceuta, Spain
| | - Alberta L Wang
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Paige Wickner
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - Anna R Wolfson
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Johnson T Wong
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
| | - Christina Yee
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Joseph Zhou
- Division of Allergy/Immunology, Boston Children's Hospital, Boston, Mass
| | - Mariana Castells
- Drug hypersensitivity and Desensitization Center, Brigham and Women's Hospital, Boston, Mass
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Hammond S, Thomson P, Meng X, Naisbitt D. In-Vitro Approaches to Predict and Study T-Cell Mediated Hypersensitivity to Drugs. Front Immunol 2021; 12:630530. [PMID: 33927714 PMCID: PMC8076677 DOI: 10.3389/fimmu.2021.630530] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/17/2021] [Indexed: 01/11/2023] Open
Abstract
Mitigating the risk of drug hypersensitivity reactions is an important facet of a given pharmaceutical, with poor performance in this area of safety often leading to warnings, restrictions and withdrawals. In the last 50 years, efforts to diagnose, manage, and circumvent these obscure, iatrogenic diseases have resulted in the development of assays at all stages of a drugs lifespan. Indeed, this begins with intelligent lead compound selection/design to minimize the existence of deleterious chemical reactivity through exclusion of ominous structural moieties. Preclinical studies then investigate how compounds interact with biological systems, with emphasis placed on modeling immunological/toxicological liabilities. During clinical use, competent and accurate diagnoses are sought to effectively manage patients with such ailments, and pharmacovigilance datasets can be used for stratification of patient populations in order to optimise safety profiles. Herein, an overview of some of the in-vitro approaches to predict intrinsic immunogenicity of drugs and diagnose culprit drugs in allergic patients after exposure is detailed, with current perspectives and opportunities provided.
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Affiliation(s)
- Sean Hammond
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
- ApconiX, Alderley Park, Alderley Edge, United Kingdom
| | - Paul Thomson
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Xiaoli Meng
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Dean Naisbitt
- MRC Centre for Drug Safety Science, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
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14
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Büyük Yaytokgil Ş, Güvenir H, Külhaş Celík İ, Yilmaz Topal Ö, Karaatmaca B, Civelek E, Toyran M, Dibek Misirlioğlu E. Evaluation of drug patch tests in children. Allergy Asthma Proc 2021; 42:167-174. [PMID: 33685563 DOI: 10.2500/aap.2021.42.200110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Patch tests are used to diagnose nonimmediate T-cell-mediated drug hypersensitivity reactions. The aim of this study was to evaluate the results of patch tests performed with suspect drugs in children. Methods: Patients < 18 years of age who had a drug patch test at the pediatric allergy outpatient clinic of our hospital between January 2014 and January 2020 were included in the study. Age, sex, culprit drug(s), reaction characteristics, and patch test results were recorded from the patients' files. Results: A total of 105 drug patch tests were performed on 71 patients during the study period. The patients' median age was 7 years (interquartile range, 4-11 years), and 57.7% (n = 41) were boys. Twenty-three patients (32.3%) had severe cutaneous adverse reaction (Stevens-Johnson syndrome in 11, drug reaction with eosinophilia and systemic symptoms in 9, and acute generalized exanthematous pustulosis in 3 patients), 45 (63.3%) had maculopapular rashes, and 3 (4.2%) had fixed drug eruption. A total of 20 patch test results (28%) were positive: 18 of 44 patch tests (40.9%) with antiepileptic drugs and 2 of 48 patch tests (4.1%) with antibiotics. Positive results were obtained in 23% of the patch tests (6/26) in 20 patients with severe cutaneous adverse reactions and in 17.7% of the patch tests (14/79) in 51 patients with mild cutaneous reactions. No adverse reactions occurred during or after the patch tests. Conclusion: In our study, patch test positivity was more common with antiepileptic drugs and in patients with severe cutaneous drug reaction.
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Affiliation(s)
- Şule Büyük Yaytokgil
- From the Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Hakan Güvenir
- Division of Pediatric Allergy and Immunology, Malatya Education and Training Hospital, Malatya, Turkey; and
| | - İlknur Külhaş Celík
- From the Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Özge Yilmaz Topal
- From the Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Betül Karaatmaca
- From the Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Ersoy Civelek
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Müge Toyran
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Emine Dibek Misirlioğlu
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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15
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Copaescu A, Gibson A, Li Y, Trubiano JA, Phillips EJ. An Updated Review of the Diagnostic Methods in Delayed Drug Hypersensitivity. Front Pharmacol 2021; 11:573573. [PMID: 33597867 PMCID: PMC7883592 DOI: 10.3389/fphar.2020.573573] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/23/2020] [Indexed: 12/19/2022] Open
Abstract
Delayed drug hypersensitivity reactions are clinically diverse reactions that vary from isolated benign skin conditions that remit quickly with no or symptomatic treatment, drug discontinuation or even continued drug treatment, to the other extreme of severe cutaneous adverse reactions (SCARs) that are associated with presumed life-long memory T-cell responses, significant acute and long-term morbidity and mortality. Diagnostic "in clinic" approaches to delayed hypersensitivity reactions have included patch testing (PT), delayed intradermal testing (IDT) and drug challenges for milder reactions. Patch and IDT are, in general, performed no sooner than 4-6 weeks after resolution of the acute reaction at the maximum non-irritating concentrations. Functional in vitro and ex vivo assays have largely remained the province of research laboratories and include lymphocyte transformation test (LTT) and cytokine release enzyme linked ImmunoSpot (ELISpot) assay, an emerging diagnostic tool which uses cytokine release, typically IFN-γ, after the patient's peripheral blood mononuclear cells are stimulated with the suspected drug(s). Genetic markers such as human leukocyte antigen have shown recent promise for both pre-prescription screening as well as pre-emptive and diagnostic testing strategies.
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Affiliation(s)
- Ana Copaescu
- Department of Infectious Diseases, Austin Health, Center for Antibiotic Allergy and Research, Heidelberg, VIC, Australia
| | - Andrew Gibson
- Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia.,Clinical Immunology and Allergy, McGill University Health Center, Montréal, Canada
| | - Yueran Li
- Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Center for Antibiotic Allergy and Research, Heidelberg, VIC, Australia.,Department of Oncology, Sir Peter MacCallum Cancer Center, The University of Melbourne, Parkville, VIC, Australia.,Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, VIC, Australia.,The National Center for Infections in Cancer, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Elizabeth J Phillips
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia.,Department of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, United States
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16
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Singh SK, Bohara A, Rai T. Comparison of Sensitivities of Skin Prick and Intradermal Tests with Oral Rechallenge Test: A Prospective Interventional Hospital-Based Study. Indian J Dermatol 2021; 66:55-59. [PMID: 33911294 PMCID: PMC8061478 DOI: 10.4103/ijd.ijd_554_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Identification of culprit drug causing adverse cutaneous drug reactions may not be possible clinically due to the intake of more than one drug. Aim: To compare the sensitivity of skin tests with gold standard oral rechallenge test to detect adverse cutaneous drug reactions. Materials and Methods: This is a prospective interventional hospital-based study of patients with adverse cutaneous drug reactions attending the outpatient department of dermatology and venereology at a tertiary care center over a 12-month period. Skin prick tests, intradermal tests, and oral rechallenge tests were performed in these patients and their sensitivities were compared. The data of quantitative nature is presented in mean and standard deviation, and categorical variables are presented in number and percentage. The sensitivity of skin tests is compared with the gold standard oral rechallenge test. Results: A total of 49 patients with adverse cutaneous drug reactions were evaluated. Clinical spectrum of adverse cutaneous drug reactions ranged from mild to severe, with fixed drug eruption being the commonest (55.1%) followed by maculopapular exanthem (32.7%). The highest incidence was with fluoroquinolones (43.8%) followed by nonsteroidal anti-inflammatory drugs. Fluoroquinolones were the major cause of fixed drug eruption followed by nonsteroidal anti-inflammatory drugs. The sensitivity of skin prick test and intradermal tests were 49% and 73%, respectively and the difference was highly significant (P < 0.001). The difference in sensitivity in skin prick test versus oral rechallenge test and intradermal test versus oral rechallenge test was also highly significant (P < 0.001). Limitations: Small sample size was a major limitation. Histopathological examinations and human leukocyte antigen associations could not be done. Conclusion: Predominant causative drugs were fluoroquinolones followed by nonsteroidal anti-inflammatory drugs. Sensitivities of skin prick test and intradermal test were quite good and these skin tests should be performed before oral rechallenge test in cases of adverse cutaneous drug reactions.
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Affiliation(s)
- Satyendra K Singh
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ayushi Bohara
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tulika Rai
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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17
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Patch Testing in Adverse Drug Reactions. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft-Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3 guidelines: Epicutaneous patch testing with contact allergens and drugs - Short version, Part 1. J Dtsch Dermatol Ges 2020; 17:1076-1093. [PMID: 31631537 DOI: 10.1111/ddg.13956] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens. Note: This publication is part 1 of the short version of the S3 guidelines for "Epicutaneous patch testing using contact allergens and drugs" (registry no. 013 - 018; date: March 20, 2019; valid until December 31, 2021). Part 2 of the short version will be published in the next issue. The long version of these guidelines can be accessed at www.awmf.org. The method report is available as online publication (https://www.awmf.org/leitlinien/detail/ll/013-018.html) and contains the evidence tables in its appendix.
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Affiliation(s)
- Vera Mahler
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Paul-Ehrlich-Institut, Langen, Germany
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Detlef Becker
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Jochen Brasch
- Department of Dermatology, Venereology und Allergology, University Medical Center, Kiel, Germany
| | - Kristine Breuer
- Dermatology Practice (Dermatologie Reinbek), Reinbek, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology und Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans Drexler
- Institute for Occupational, Social and Environmental Medicine, Friedrich--Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Burkhard Kreft
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Silvia Pleschka
- German Allergy and Asthma Foundation (Deutscher Allergie- und Asthmabund e.V.), Mönchengladbach, Germany
| | - Maria Portisch
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Petra Spornraft-Ragaller
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Medical Center, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, , Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology und Allergology, Charité - UniversityMedicine, Berlin, Germany
| | - Axel Schnuch
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Centre Göttingen, Göttingen, Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Medical Faculty, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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19
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Santiago LG, Morgado FJ, Baptista MS, Gonçalo M. Hypersensitivity to antibiotics in drug reaction with eosinophilia and systemic symptoms (DRESS) from other culprits. Contact Dermatitis 2020; 82:290-296. [DOI: 10.1111/cod.13462] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/29/2019] [Accepted: 01/02/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Luis G. Santiago
- Department of DermatologyCoimbra University Hospital Coimbra Portugal
| | | | | | - Margarida Gonçalo
- Department of DermatologyCoimbra University Hospital Coimbra Portugal
- Faculty of MedicineUniversity of Coimbra Coimbra Portugal
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20
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21
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft‐Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3‐Leitlinie: Durchführung des Epikutantests mit Kontaktallergenen und Arzneimitteln – Kurzfassung Teil 1. J Dtsch Dermatol Ges 2019; 17:1075-1093. [DOI: 10.1111/ddg.13956_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
- Paul‐Ehrlich‐Institut Langen
| | - Alexander Nast
- Division of Evidence‐Based Medicine (dEBM)Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin Berlin
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | | | - Jochen Brasch
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Schleswig‐Holstein Kiel
| | | | - Heinrich Dickel
- Klinik für DermatologieVenerologie und AllergologieSt. Josef‐Hospital Ruhr‐Universität Bochum Bochum
| | - Hans Drexler
- Institut für Arbeits‐, Sozial‐ und Umweltmedizin der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena Jena
| | - Johannes Geier
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück Osnabrück
| | - Burkhard Kreft
- Klinik und Poliklinik für Dermatologie und VenerologieUniversitätsklinikum Halle (Saale) Halle
| | | | - Hans Merk
- Univ.‐Professor für Dermatologie & AllergologieDirektor (em.) der Hautklinik – RWTH Aachen University Aachen
| | - Hagen Ott
- Hannoversche Kinderheilanstalt (HKA): Kinder‐ und Jugendkrankenhaus auf der Bult Hannover
| | | | - Maria Portisch
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Petra Spornraft‐Ragaller
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | - Elke Weisshaar
- Berufsdermatologie, Hautklinik, Universitätsklinikum Heidelberg Heidelberg
| | - Thomas Werfel
- Klinik für Dermatologie, Allergologie und VenerologieMedizinische Hochschule Hannover Hannover
| | - Margitta Worm
- Klinik für Dermatologie, Venerologie und Allergologie Charité ‐ Universitätsmedizin Berlin Berlin
| | - Axel Schnuch
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Wolfgang Uter
- Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)Medizinische Fakultät der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
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22
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Usefulness of Cutaneous Provocation Tests to Study Drugs Responsible for Cutaneous Adverse Drug Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0198-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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23
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Khan DA, Banerji A, Bernstein JA, Bilgicer B, Blumenthal K, Castells M, Ein D, Lang DM, Phillips E. Cephalosporin Allergy: Current Understanding and Future Challenges. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:2105-2114. [PMID: 31495420 PMCID: PMC6955146 DOI: 10.1016/j.jaip.2019.06.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 01/13/2023]
Abstract
Cephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.
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Affiliation(s)
- David A. Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8859
| | - Aleena Banerji
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Cox 201, MGH, 55 Fruit St, Boston, MA 02114
| | - Jonathan A. Bernstein
- Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML#563, Cincinnati, OH 45267-0563
| | - Basar Bilgicer
- Department of Chemical and Biomedical Engineering, 205 McCourtney Hall, Notre Dame, IN 46556-5637
| | - Kimberly Blumenthal
- Department of Medicine, Division of Rheumatology, Allergy & Immunology, Massachusetts General Hospital, Cox 201, MGH, 55 Fruit St, Boston, MA 02114
| | - Mariana Castells
- Department of Medicine, Division of Rheumatology, Allergy and Immunology, Brigham and Women’s Hospital, 60 Fenwood Rd Hale Building, Boston, MA 02115
| | - Daniel Ein
- Department of Internal Medicine, George Washington University Medical Center, 2300 M St. NW, Washington DC 20037
| | - David M. Lang
- Department of Internal Medicine, Cleveland Clinic, Respiratory Institute, Department of Allergy and Clinical Immunology, 9500 Euclid Ave-A90, Cleveland, OH 44195
| | - Elizabeth Phillips
- Department of Medicine, Vanderbilt University Medical Center, 1161-21 St Ave S, A-2200 MCN, Nashville, TN 3732-2582
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Ngwasiri CA, Abanda MH, Aminde LN. Ivermectin-induced fixed drug eruption in an elderly Cameroonian: a case report. J Med Case Rep 2018; 12:254. [PMID: 30201032 PMCID: PMC6131839 DOI: 10.1186/s13256-018-1801-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 08/13/2018] [Indexed: 11/03/2022] Open
Abstract
Background Cutaneous adverse reactions to medications are extremely common and display characteristic clinical morphology. A fixed drug eruption is a cutaneous adverse drug reaction due to type IV or delayed cell-mediated hypersensitivity. Ivermectin, a broad-spectrum anti-parasitic compound, has been an essential component of public health campaigns targeting the control of two devastating neglected tropical diseases: onchocerciasis (river blindness) and lymphatic filariasis. Case presentation We report the case of a 75-year-old Cameroonian man of the Bamileke ancestry who developed multiple fixed drug eruptions a few hours following ivermectin intake that worsened with repeated drug consumption. Discontinuation of the drug, counselling, systemic steroids, and orally administered antihistamines were the treatment modalities employed. Marked regression of the lesions ensued with residual hyperpigmentation and dyschromia. Conclusion Keen observation on the part of physicians is mandatory during the administration of ivermectin for quick recognition and prevention of this adverse drug reaction.
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Affiliation(s)
- Calypse Asangbe Ngwasiri
- Bamendjou District Hospital, Bamendjou, West Region, Cameroon. .,Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.
| | | | - Leopold Ndemnge Aminde
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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25
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Zhang J, Li X, Su Y, Sun M, Wang J, Hao Y. Association between HLA gene polymorphism and cutaneous adverse reactions caused by antiepileptic drugs. Exp Ther Med 2018; 15:3399-3403. [PMID: 29545861 PMCID: PMC5840917 DOI: 10.3892/etm.2018.5801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022] Open
Abstract
The association between cutaneous adverse drug reactions (cADRs) caused by antiepileptic drugs (AEDs) and human leukocyte antigen-A (HLA-A) and HLA-B genes in Chinese Han population in Shanghai was investigated. Through the case-control study, 30 child patients with AED-induced cADRs (cADRs group), 60 AED-tolerant child patients (AED-tolerant group) and 60 normal children not taking AEDs (normal group) were collected. The HLA-B*15:02 and HLA-A*31:01 genotypes were detected using the polymerase chain reaction-sequence-specific oligonucleotide (PCR-SSO) probe method, and the correlation of HLA-B*15:02 and HLA-A*31:01 genes with the incidence of cADRs was analyzed. The positive rate of HLA-B*15:02 gene was 83.33% in the cADRs group, which was significantly increased compared with that in the AED-tolerant and normal groups (P<0.01). The positive rate of HLA-A*31:01 gene was 63.33% in the cADRs group, which was obviously increased compared with that in the AED-tolerant and normal groups (P<0.01). There were no significant differences in HLA-B*15:02 and HLA-A*31:01 genotypes between the AED-tolerant and normal groups (P>0.05). The results showed that HLA-B*15:02 and HLA-A*31:01 are significantly associated with cADRs in a Chinese Han population in Shanghai, suggesting that HLA-B*15:02 and HLA-A*31:01 genotypes should be detected in the application of AEDs.
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Affiliation(s)
- Jingang Zhang
- Department of Neurology, Tianyou Hospital, Tongji University, Shanghai 200331, P.R. China.,Department of Neurology, Dahua Hospital, Shanghai 200331, P.R. China
| | - Xinrui Li
- Department of Neurology, Tianyou Hospital, Tongji University, Shanghai 200331, P.R. China
| | - Yuanyuan Su
- Department of Neurology, Tianyou Hospital, Tongji University, Shanghai 200331, P.R. China
| | - Min Sun
- Department of Cardiology, Shandong Energy Zaozhuang Mining Group Central Hospital, Zaozhuang, Shandong 277800, P.R. China
| | - Junbang Wang
- Translational Stem Cell Research Center, Tongji Hospital, Tongji University School of Medicine, Shanghai 200331, P.R. China
| | - Yunhua Hao
- Department of Neurology, Tianyou Hospital, Tongji University, Shanghai 200331, P.R. China
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Ranugha PSS, Betkerur J. Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives. Indian J Dermatol Venereol Leprol 2018; 84:137-147. [DOI: 10.4103/ijdvl.ijdvl_992_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Prasertvit P, Chareonyingwattana A, Wattanakrai P. Nevirapine patch testing in Thai human immunodeficiency virus infected patients with nevirapine drug hypersensitivity. Contact Dermatitis 2017; 77:379-384. [DOI: 10.1111/cod.12849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 05/23/2017] [Accepted: 05/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Piyatida Prasertvit
- Faculty of Medicine, Division of Dermatology, Department of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand 10400
| | - Angkana Chareonyingwattana
- Center for Medical Genomics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Bangkok Thailand
| | - Penpun Wattanakrai
- Faculty of Medicine, Division of Dermatology, Department of Medicine; Ramathibodi Hospital, Mahidol University; Bangkok Thailand 10400
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Assier H, Valeyrie-Allanore L, Gener G, Verlinde Carvalh M, Chosidow O, Wolkenstein P. Patch testing in non-immediate cutaneous adverse drug reactions: value of extemporaneous patch tests. Contact Dermatitis 2017; 77:297-302. [PMID: 28730661 DOI: 10.1111/cod.12842] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/06/2017] [Accepted: 05/12/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patch testing following a standardized protocol is reliable for identifying the culprit drug in cutaneous adverse drug reactions (CADRs). However, these patch tests (PTs) require pharmaceutical material and staff, which are not always easily available. OBJECTIVES To evaluate an extemporaneous PT method in CADRs. METHODS We retrospectively analysed data for all patients referred to our department between March 2009 and June 2013 for patch testing after a non-immediate CADR. The patients who supplied their own suspected drugs were tested both with extemporaneous PTs and with conventional PTs. Extemporaneous PTs involved a nurse crushing and diluting the drug in pet. in a ratio of approximately one-third to two-thirds. Standardized PTs were performed according to guidelines, with commercial drugs diluted to 30% or with active ingredients diluted to 10%. We analysed the data for the two PT methods in terms of the number of positive test reactions, drugs tested, and type of CADR for patients in whom the two PT methods were used. RESULTS In total, 75 of 156 patients underwent the two PT procedures, including 91 double tests. Overall, 21 tests gave positive reactions with the two methods, and 69 other tests gave negative results with the two methods. CONCLUSION Our series yielded results similar to those of published series concerning the types of CADR and the drugs responsible. Our results suggest that, for CADRs, if a patient supplies a suspected drug but if the pharmaceutical material and staff are not available for conventional PTs, extemporaneous PTs performed by the nurse with the commercial drug used by the patient can be useful and reliable.
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Affiliation(s)
- Haudrey Assier
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France
| | - Laurence Valeyrie-Allanore
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
| | - Gwendeline Gener
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France
| | | | - Olivier Chosidow
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
| | - Pierre Wolkenstein
- Department of Dermatology, Referral Centre for Toxic Bullous Diseases, AP-HP, Hôpital Henri-Mondor, UPEC, 94010, Créteil, France.,EA 7379 EpiDermE, UPEC, 94010, Créteil, France
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Romano A, Valluzzi RL, Caruso C, Maggioletti M, Gaeta F. Non-immediate Cutaneous Reactions to Beta-Lactams: Approach to Diagnosis. Curr Allergy Asthma Rep 2017; 17:23. [PMID: 28382604 DOI: 10.1007/s11882-017-0691-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Non-immediate cutaneous reactions (i.e., occurring at least 1 h after the initial drug administration), particularly maculopapular exanthemas and urticarial eruptions, are common during beta-lactam treatments. A T cell-mediated pathogenic mechanism has been demonstrated in some cutaneous reactions, such as maculopapular exanthema, fixed drug eruption, acute generalized exanthematous pustulosis, and drug-induced hypersensitivity syndrome. In the diagnostic work-up, patch testing is useful, together with delayed-reading intradermal testing. Patch tests are a simple and safe diagnostic tool, which in the case of severe reactions should be used as the first line of investigation. However, patch tests are less sensitive than intradermal tests, which are preferable in subjects with mild reactions. Lymphocyte transformation or activation tests and enzyme-linked immunosorbent spot assays can be used as complementary tests. In selected cases of mild or moderate reactions, displaying negative results in the aforesaid allergy tests, a graded challenge with the implicated beta-lactam can be performed.
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Affiliation(s)
- Antonino Romano
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy. .,IRCCS Oasi Maria S.S, Troina, Italy.
| | - Rocco Luigi Valluzzi
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy.,Department of Pediatrics, Division of Allergy, Pediatric Hospital Bambino Gesù, Rome, Vatican City, Italy
| | - Cristiano Caruso
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
| | | | - Francesco Gaeta
- Allergy Unit, Presidio Columbus, Via G. Moscati, 31, 00168, Rome, Italy
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Pinho A, Marta A, Coutinho I, Gonçalo M. Long-term reproducibility of positive patch test reactions in patients with non-immediate cutaneous adverse drug reactions to antibiotics. Contact Dermatitis 2016; 76:204-209. [PMID: 27910104 DOI: 10.1111/cod.12720] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/05/2016] [Accepted: 10/10/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND As in contact allergy, T cell-mediated hypersensitivity in non-immediate (NI) cutaneous adverse drug reactions (CADRs) to antibiotics is considered to be lifelong, but, in this setting, patch tests have rarely been repeated after long time intervals. OBJECTIVE To evaluate the long-term reproducibility of positive patch test reactions to antibiotics in patients with NI CADRs. METHODS Fifty-six patients with NI CADRs to antibiotics who had relevant positive reactions during patch testing were invited to repeat patch tests with a similar antibiotic series 2-15 years thereafter. RESULTS Twenty patients were included (9 males and 11 females; mean age 54.6 years): 18 with maculopapular exanthema, 1 with drug hypersensitivity syndrome, and 1 with acute generalized exanthematous pustulosis. Results were reproducible in 17 of 20 patients after a mean interval of 6.0 years (range 2-14.7 years). Concerning β-lactams, 7 of 8 patients remained positive for aminopenicillins, 4 of 4 for isoxazolyl penicillins, and 1 for cefoxitin. Patch test results were also reproducible for clindamycin in 5 of 7 patients, for vancomycin in 1 patient, and for spiramycin in 1 patient. Reproducibility was not affected by the time interval between tests, sex, or age at testing. CONCLUSIONS In the context of NI CADRs, we showed high reproducibility of positive patch test reactions to various antibiotics, even after several years.
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Affiliation(s)
- André Pinho
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal
| | - Ana Marta
- Faculty of Medicine, Clinic of Dermatology, University of Coimbra, 3000-045, Coimbra, Portugal
| | - Inês Coutinho
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal
| | - Margarida Gonçalo
- Dermatology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, 3000-045, Coimbra, Portugal.,Faculty of Medicine, Clinic of Dermatology, University of Coimbra, 3000-045, Coimbra, Portugal
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Hassoun-Kheir N, Bergman R, Weltfriend S. The use of patch tests in the diagnosis of delayed hypersensitivity drug eruptions. Int J Dermatol 2016; 55:1219-1224. [DOI: 10.1111/ijd.13306] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/21/2015] [Accepted: 12/28/2015] [Indexed: 02/06/2023]
Affiliation(s)
- Nasreen Hassoun-Kheir
- Department of Dermatology; Rambam Medical Health Campus and The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology; Haifa Israel
| | - Reuven Bergman
- Department of Dermatology; Rambam Medical Health Campus and The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology; Haifa Israel
| | - Sara Weltfriend
- Department of Dermatology; Rambam Medical Health Campus and The Bruce Rappaport Faculty of Medicine, Technion Institute of Technology; Haifa Israel
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Pinho A, Coutinho I, Gameiro A, Gouveia M, Gonçalo M. Patch testing - a valuable tool for investigating non-immediate cutaneous adverse drug reactions to antibiotics. J Eur Acad Dermatol Venereol 2016; 31:280-287. [PMID: 27477905 DOI: 10.1111/jdv.13796] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 05/06/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Antibiotics are among the most frequent causes of cutaneous adverse drug reactions (CADR); patch testing may be an important tool in their evaluation and management. We assessed the role of patch testing as a diagnostic tool in non-immediate CADR to antibiotics, and evaluated cross-reactivity among them. METHODS We reviewed data from all patients with non-immediate CADR attributed to antibiotics, which were patch tested between 2000 and 2014 at our dermatology department. RESULTS Patch tests were performed in 260 patients, and showed overall reactivity to antibiotics of 21.5%, especially in the context of drug reactions with eosinophilia and systemic symptoms (DRESS) (31.6%), maculopapular exanthema (MPE) (21.8%), Stevens-Johnson syndrome/toxic epidermal necrolysis (20%) and acute generalized exanthematous pustulosis (AGEP) (18.1%). Patch test reactivity was higher for amoxicillin, mainly in DRESS (44.4%) and MPE (25.6%), and dicloxacillin (50% in AGEP and 37.5% in MPE). Reactivity to clindamycin occurred, especially in the setting of MPE (23.2%). In AGEP and DRESS, patch tests were useful in detecting reactivity to quinolones (50-100%). Overall reactivity was lower for vancomycin (9.1%), co-trimoxazole (8.6%), macrolides (4.8%) and cephalosporins (4.4%). Positive patch tests for more than one antibiotic occurred in 29/56 cases (51.8%), mostly explained by cross-reactions. Twenty of 24 cases reacted to both amoxicillin and ampicillin. All five cases reacting to ciprofloxacin cross-reacted with other quinolones. CONCLUSION Although oral rechallenge is considered the gold standard for confirming drug imputability in CADR, patch testing could be suggested as a first choice in the study of non-immediate reactions, since it is a safe and valuable procedure.
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Affiliation(s)
- A Pinho
- Department of Dermatology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - I Coutinho
- Department of Dermatology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Gameiro
- Department of Dermatology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Gouveia
- Department of Dermatology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - M Gonçalo
- Department of Dermatology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Clinic of Dermatology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Fonacier L, Bernstein DI, Pacheco K, Holness DL, Blessing-Moore J, Khan D, Lang D, Nicklas R, Oppenheimer J, Portnoy J, Randolph C, Schuller D, Spector S, Tilles S, Wallace D. Contact dermatitis: a practice parameter-update 2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 3:S1-39. [PMID: 25965350 DOI: 10.1016/j.jaip.2015.02.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/08/2023]
Abstract
This parameter was developed by the Joint Task Force on Practice Parameters, which represents the American Academy of Allergy, Asthma & Immunology (AAAAI); the American College of Allergy, Asthma & Immunology (ACAAI); and the Joint Council of Allergy, Asthma & Immunology. The AAAAI and the ACAAI have jointly accepted responsibility for establishing "Contact Dermatitis: A Practice Parameter-Update 2015." This is a complete and comprehensive document at the current time. The medical environment is changing and not all recommendations will be appropriate or applicable to all patients. Because this document incorporated the efforts of many participants, no single individual, including members serving on the Joint Task Force, are authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information or interpretation of this practice parameter by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma & Immunology. These parameters are not designed for use by the pharmaceutical industry in drug development or promotion. Previously published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology are available at http://www.JCAAI.org or http://www.allergyparameters.org.
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Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, Khan N, Pirmohamed M, Clark AT, Nasser SM. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy 2015; 45:300-27. [PMID: 25623506 DOI: 10.1111/cea.12468] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 12/15/2022]
Abstract
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.
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Affiliation(s)
- R Mirakian
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Ónodi-Nagy K, Kinyó Á, Meszes A, Garaczi E, Kemény L, Bata-Csörgő Z. Amoxicillin rash in patients with infectious mononucleosis: evidence of true drug sensitization. Allergy Asthma Clin Immunol 2015; 11:1. [PMID: 25784943 PMCID: PMC4362637 DOI: 10.1186/1710-1492-11-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/08/2014] [Indexed: 11/10/2022] Open
Abstract
Background It hasn’t been clearly understood yet whether sensitization to antibiotics, the virus itself or transient loss of drug tolerance due to the virus, is responsible for the development of maculopapular exanthems following amoxicillin intake in patients with infectious mononucleosis. We aimed to examine whether sensitization to penicillin developed among patients with skin rash following amoxicillin treatment within infectious mononucleosis. Methods Ten patients were investigated for drug sensitization by lymphocyte transformation test and six patients were further tested by prick-, intradermal and patch tests employing the penicillin’s main antigens. Results Lymphocyte transformation test showed negative results with amoxicillin, while one patient had positive reaction to cefixime. Six patients with suspected sensitization to amoxicillin were then investigated by in vivo tests. Prick tests were negative in all six patients, but the intradermal tests showed positive reactions in four patients. Conclusions Our data demonstrate that in vitro testing is not sensitive enough in determining drug sensitization to penicillin. In vivo tests should be performed to detect sensitization and indeed with skin tests our results confirmed that sensitization to aminopenicillin may develop within infectious mononucleosis.
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Affiliation(s)
- Katinka Ónodi-Nagy
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary
| | - Ágnes Kinyó
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary
| | - Angéla Meszes
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary
| | - Edina Garaczi
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary
| | - Lajos Kemény
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary ; Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Bata-Csörgő
- Department of Dermatology and Allergology, University of Szeged, Albert Szent-Györgyi Medical Center, Korányi fasor 6, Szeged, 6720 Hungary ; Dermatological Research Group of the Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
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Solensky R, Khan DA. Evaluation of antibiotic allergy: the role of skin tests and drug challenges. Curr Allergy Asthma Rep 2014; 14:459. [PMID: 25142495 DOI: 10.1007/s11882-014-0459-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Antibiotic allergies are frequently reported in both adult and pediatric populations. While a detailed drug history is essential in the evaluation of antibiotic allergy, the history is typically insufficient to determine the presence of a drug allergy. The most readily available diagnostic testing for evaluating antibiotic allergies are drug skin testing and drug challenges. This review will focus on updates in the evaluation of antibiotic allergy utilizing immediate skin tests, delayed intradermal testing, drug patch tests, and drug challenges for both adults and children with histories of antibiotic allergies.
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Möbs C, Pfützner W. Cellular in vitro diagnosis of adverse drug reactions. ACTA ACUST UNITED AC 2014; 23:164-171. [PMID: 26120528 PMCID: PMC4479488 DOI: 10.1007/s40629-014-0020-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/08/2014] [Indexed: 12/11/2022]
Abstract
Adverse drug reactions can manifest clinically in a variety of ways. Whilst the majority can be explained by dose-dependent side effects, there is group of unpredictable immunological or non-immunological intolerances that represent a particular diagnostic challenge. Skin tests are frequently negative, whilst challenge tests are time-consuming and often hazardous. Against this backdrop, cellular in vitro tests play a particularly important role in the identification of the causative drug. Whilst basophil tests can be used in the case of immunoglobulin E (IgE)- as well as non-IgE-mediated hypersensitivity reactions, T-cellular test methods assist in the diagnosis of drug eruptions. The reliability of individual tests can be affected by a variety of parameters, such as the pathomechanism underlying the drug reaction, the causative medication, or the point in time of testing. Not only is a sound knowledge of the basic principles of the individual assays an essential prerequisite for correctly indicating and interpreting this test method, but also an awareness of these additional factors.
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Affiliation(s)
- Christian Möbs
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany ; Clinical & Experimental Allergy, Allergy Center Hessen, Department of Dermatology and Allergology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany
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Zelluläre In-vitro-Diagnostik von Arzneimittelreaktionen. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Brajon D, Menetre S, Waton J, Poreaux C, Barbaud A. Non-irritant concentrations and amounts of active ingredient in drug patch tests. Contact Dermatitis 2014; 71:170-5. [DOI: 10.1111/cod.12269] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 04/30/2014] [Accepted: 05/10/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Delphine Brajon
- Dermatology and Allergy Department; Brabois Hospital, Batiment des Specialites Medicales, University Hospital of Nancy; Rue du Morvan 54500 Vandoeuvre les Nancy France
| | - Sophie Menetre
- Pharmacy Department; Brabois Hospital, University Hospital of Nancy; Rue du Morvan 54500 Vandoeuvre les Nancy France
| | - Julie Waton
- Dermatology and Allergy Department; Brabois Hospital, Batiment des Specialites Medicales, University Hospital of Nancy; Rue du Morvan 54500 Vandoeuvre les Nancy France
- Faculte de Medecine, Research Unit EA 72-98 ‘INGRES’, Lorraine University; 54500 Vandoeuvre les Nancy France
| | - Claire Poreaux
- Dermatology and Allergy Department; Brabois Hospital, Batiment des Specialites Medicales, University Hospital of Nancy; Rue du Morvan 54500 Vandoeuvre les Nancy France
| | - Annick Barbaud
- Dermatology and Allergy Department; Brabois Hospital, Batiment des Specialites Medicales, University Hospital of Nancy; Rue du Morvan 54500 Vandoeuvre les Nancy France
- Faculte de Medecine, Research Unit EA 72-98 ‘INGRES’, Lorraine University; 54500 Vandoeuvre les Nancy France
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Gendelman SR, Pien LC, Gutta RC, Abouhassan SR. Modified oral metronidazole desensitization protocol. ALLERGY & RHINOLOGY 2014; 5:66-9. [PMID: 24612959 PMCID: PMC4124580 DOI: 10.2500/ar.2014.5.0080] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Center for Disease Control guidelines recommend desensitization to metronidazole in patients with trichomoniasis and hypersensitivity to metronidazole. There is only one published oral metronidazole desensitization protocol. The purpose of this study was to design a new, more gradual oral desensitization protocol to decrease systemic reactions that may occur when using the previously published protocol. We present two patients with presumed IgE-mediated allergy to metronidazole who underwent oral desensitization using our modified protocol. Case 1 was a 65-year-old woman with trichomoniasis who presented for metronidazole desensitization with a history of intraoperative anaphylaxis and positive skin tests to metronidazole. The patient tolerated six doses of the modified desensitization but developed systemic symptoms of nasal congestion and diffuse pruritus after the 25- and 100-mg doses. Both reactions were treated with intravenous (i.v.) antihistamines. Because of gastrointestinal irritation, the desensitization was completed at a dose of 250 mg orally every 6 hours. Case 2 was a 42-year-old woman with trichomoniasis and a history of hives immediately after administration of i.v. metronidazole who presented for desensitization. The patient had negative skin-prick and intradermal testing to metronidazole. She developed lip tingling and pruritus on her arms 15 minutes after the 10-mg dose. Fexofenadine at 180 mg was given orally and symptoms resolved. She tolerated the rest of the protocol without reaction and received a total dose of 2 g of metronidazole. Our oral metronidazole desensitization for presumed IgE-mediated reactions offers a second option for physicians wishing to use a more gradual escalation in dose.
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Affiliation(s)
- Samantha R Gendelman
- Department of Allergy and Immunology, Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio, USA
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Barbaud A. Drug skin tests and systemic cutaneous adverse drug reactions: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2.4.481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Rodilla EM, González ID, Yges EL, Bellido FJM, Bara MTG, Toledano FL. Immunological aspects of nonimmediate reactions to β-lactam antibiotics. Expert Rev Clin Immunol 2014; 6:789-800. [DOI: 10.1586/eci.10.53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Liippo J, Pummi K, Hohenthal U, Lammintausta K. Patch testing and sensitization to multiple drugs. Contact Dermatitis 2013; 69:296-302. [DOI: 10.1111/cod.12076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 01/21/2013] [Accepted: 02/09/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Jussi Liippo
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
| | - Kati Pummi
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
- Department of Pathology; Turku University Hospital; 20521 Turku Finland
| | - Ulla Hohenthal
- Department of Internal Medicine; Turku University Hospital; 20521 Turku Finland
| | - Kaija Lammintausta
- Department of Dermatology; Turku University Hospital; 20521 Turku Finland
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Ramasamy SN, Korb-Wells CS, Kannangara DRW, Smith MWH, Wang N, Roberts DM, Graham GG, Williams KM, Day RO. Allopurinol Hypersensitivity: A Systematic Review of All Published Cases, 1950–2012. Drug Saf 2013; 36:953-80. [DOI: 10.1007/s40264-013-0084-0] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Salava A, Alanko K, Hyry H. Dipyridamole-induced eczematous drug eruption with positive patch test reaction. Contact Dermatitis 2012; 67:103-4. [DOI: 10.1111/j.1600-0536.2012.02066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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