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Guyénard L, Tauber M, Debord-Peguet S, Berard F, Nosbaum A, Hacard F, Castells M, Nicolas JF. Case Report: Mast cell anergy: absence of symptoms after accidental re-exposure to amoxicillin/clavulanic acid 3 days after anaphylaxis. FRONTIERS IN ALLERGY 2024; 5:1366922. [PMID: 38529125 PMCID: PMC10961332 DOI: 10.3389/falgy.2024.1366922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Empty mast cell syndrome, also named post anaphylaxis mast cell anergy (PAMA), is a temporary state of loss of mast cell responsiveness after a severe immediate hypersensitivity reaction. In this study, we describe a case of PAMA after accidental re-exposure to amoxicillin in a patient who developed severe anaphylaxis to this drug three days earlier in the operating room. To our knowledge, this report is the second to document this phenomenon.
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Affiliation(s)
- Loris Guyénard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Marie Tauber
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Sophie Debord-Peguet
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
- Service d’Anesthésie-Réanimation Civilo-Militaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Berard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Audrey Nosbaum
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Florence Hacard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Mariana Castells
- Drug Hypersensitivity and Desensitization Center, Mastocytosis Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Jean-François Nicolas
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
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Li PH, Wong JCY, Chan JMC, Chik TSH, Chu MY, Ho GCH, Leung WS, Li TCM, Ng YY, Shum R, Sin WWY, Tso EYK, Wu AKL, Au EYL. Hong Kong Drug Allergy Delabelling Initiative (HK-DADI) consensus statements for penicillin allergy testing by nonallergists. FRONTIERS IN ALLERGY 2022; 3:974138. [PMID: 36133403 PMCID: PMC9483020 DOI: 10.3389/falgy.2022.974138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Penicillin allergy testing has been traditionally performed by allergists, but there remains a huge deficit of specialists. A multidisciplinary effort with nonallergists would be invaluable to overcome the magnitude of penicillin allergy labels via the Hong Kong Drug Allergy Delabelling Initiative (HK-DADI). These consensus statements (CSs) offer recommendations and guidance to enable nonallergists to screen for low-risk (LR) patients and perform penicillin allergy testing. Methods CSs were formulated by the HK-DADI Group using the Delphi method. An agreement was defined as greater than or equal to 80% consensus. Results A total of 26 CSs reached consensus after multiple rounds of Delphi. CSs were categorized into risk assessment, skin testing, drug provocation testing (DPT), and post-testing management. For risk assessment, the essentials of allergy history and exclusion criteria were detailed. Patients with only LR features can proceed with testing by nonallergists. Skin tests should be performed prior to DPT. Details regarding the timing, preparation, and interpretation of skin tests were elaborated. DPT remains the gold standard to diagnose genuine allergy or tolerance and should be performed when there is a low pretest probability following negative skin testing. Details of DPT preparations, dosing protocols, and interpretation were elaborated. For post-testing management, inaccurate allergy labels should be delabeled following negative DPT with proper patient counseling. Conclusion CSs support penicillin allergy testing by nonallergists in Hong Kong. LR cases can be managed by nonallergists at Spoke Clinics, with training and support of an allergist-led Hub.
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Affiliation(s)
- Philip H. Li
- Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Correspondence: Philip H. Li
| | - Jane C. Y. Wong
- Division of Rheumatology & Clinical Immunology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Jacky M. C. Chan
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Thomas S. H. Chik
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - M. Y. Chu
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Grace C. H. Ho
- Division of Rheumatology, Department of Medicine, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - W. S. Leung
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Kwong Wah Hospital, Hong Kong SAR, China
| | - Timothy C. M. Li
- Division of Infectious Diseases, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong SAR, China
| | - Y. Y. Ng
- Division of Infectious Diseases, Department of Medicine & Geriatrics, Tuen Mun Hospital, Hong Kong SAR, China
| | - Rocky Shum
- Division of Microbiology, Department of Clinical Pathology, Tuen Mun Hospital, Hong Kong SAR, China
| | - Winnie W. Y. Sin
- Division of Infectious Diseases, Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
| | - Eugene Y. K. Tso
- Division of Infectious Diseases, Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong SAR, China
| | - Alan K. L. Wu
- Division of Microbiology, Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - Elaine Y. L. Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong SAR, China
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