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Ventura MT, Boni E, Cecere R, Buquicchio R, Calogiuri GF, Martignago I, Incorvaia C, Ridolo E. Importance of hypersensitivity in adverse reactions to drugs in the elderly. Clin Mol Allergy 2018; 16:7. [PMID: 29618951 PMCID: PMC5880019 DOI: 10.1186/s12948-018-0083-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 02/13/2018] [Indexed: 11/10/2022] Open
Abstract
Background The use of drugs in the elderly is very extensive because of the frequent occurrence of chronic diseases. Adverse drug reactions (ADRs) commonly occur in geriatric patients receiving multiple therapeutic regimens. In the literature, little attention has been given to ADRs in the elderly, and particularly to allergic reactions. Objective The aim of the present study is to provide data on possible inappropriate prescriptions in the elderly in relation to allergic reactions and to identify a list of drugs which are likely inducers of allergic reactions. Methods We retrospectively evaluated ADRs in patients referring to Immunoallergy Unit of Hospital Policlinico in Bari on the basis of Beers criteria. Among adverse reactions, hypersensitivity reactions were extracted and a comparison between different age groups was assessed. Results Out of 823 patients with ADRs, in 30.6% hypersensitivity drug reactions (HDR) were diagnosed. Data about drug intake, comorbidities and clinical presentation were collected, aiming to identify possible risk factors. An evaluation of drugs most commonly involved was assessed. Conclusions HDR are reported to represent 5-10% of all ADRs, while in our study population the prevalence was about 30%. This suggests the need to develop strategies to minimize the incidence of drug allergy in the elderly, as well to reduce the phenomenon of inappropriate prescriptions.
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Affiliation(s)
| | | | - Rosa Cecere
- 1Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | - Rosalba Buquicchio
- 1Department of Interdisciplinary Medicine, University of Bari, Bari, Italy
| | | | - Irene Martignago
- 4Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43126 Parma, Italy
| | | | - Erminia Ridolo
- 4Medicine and Surgery Department, University of Parma, Via Gramsci 14, 43126 Parma, Italy
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Ventura MT, Sanapo F, Calogiuri GF, Satriano F. Anaphylaxis Induced by Intramuscular Betamethasone Disodium Phosphate: Reflections on a Clinical Case. Int J Immunopathol Pharmacol 2016; 20:387-91. [PMID: 17624252 DOI: 10.1177/039463200702000220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Glucocorticoids could be responsible for allergic symptoms correlated to an Ig-E mediated hypersensitivity mechanism. We describe the case of an anaphylactic reaction in a professional nurse, occurring after an intramuscular administration of Betamethasone. After performing skin prick tests, intramuscular tests and patch tests we concluded that the patient had Ig-E mediated sensitization. She was prescribed oral Prednisone and Deflazacort and shows good tolerance of these drugs. This demonstrates that in these patients it is possible to administrate glucocorticoids without the changes in the sites indicated by Wilkinson. Nevertheless, our patient showed a negative allergy test for Dexamethasone disodium phosphate, and in those patients sensitized to fluorinated glucocorticoids, tolerance to other glucocorticoids is not so easily predictable as in patients with hypersensitivity to first generation steroids or in corticosteroid contact dermatitis, according to the four patterns of cross-reactivity proposed by Coopman and Dooms-Goossens.
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Affiliation(s)
- M T Ventura
- Cattedra di Allergologia ed Immunologia Clinica, Università degli Studi di Bari, Italy.
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Lee JH, Oh HS, Kwon BS, Park H, Park S, Kim JH, Kim HJ, Kwon HS, Cho YS, Moon HB, Kim TB. Immediate-type hypersensitivity response to systemic hydrocortisone sodium succinate. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.5.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Ji-Hyang Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byoung Soo Kwon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyngjun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soyoung Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung-Hyun Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo-Jung Kim
- Department of Pulmonology and Allergy, Gyeongsang National University Hospital, Jinju, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Smith A, Trüeb RM, Theiler M, Hauser V, Weibel L. High Relapse Rates Despite Early Intervention with Intravenous Methylprednisolone Pulse Therapy for Severe Childhood Alopecia Areata. Pediatr Dermatol 2015; 32:481-7. [PMID: 25872976 DOI: 10.1111/pde.12578] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Previous data suggest that early application of intravenous methylprednisolone pulse therapy (IV-MPPT) may improve the disease course of alopecia areata. The objective of this study was to investigate the outcome of IV-MPPT in severe childhood alopecia areata, predominantly with short disease duration. METHODS Eighteen children (10 girls, 8 boys) younger than 17 years old (median age 7.7 yrs, range 2.1-16.5 yrs) treated with IV-MPPT for severe childhood alopecia areata in a referral center for pediatric dermatology over 3 years (median disease duration 4 mos, range 1-12 mos) were retrospectively evaluated. Five patients had alopecia areata totalis or universalis and 13 had alopecia multilocularis. The median scalp area affected by alopecia was 60% (range 30%-100%). All patients underwent two or three cycles of IV-MPPT at monthly intervals (maximum 500 mg/day on three consecutive days). RESULTS Within 7 months after the last IV-MPPT session, 10 of 18 children had good response (≥75% of hair regrowth), with eight showing improvement within the first 4 months. Of the remaining eight patients, one had moderate response (50%-74% regrowth), three had poor response (1%-49% regrowth), and four (all with alopecia areata universalis or totalis) had no response. Seven of the initial 10 good responders experienced relapses, with marked hair loss after the last IV-MPPT session. The estimated median time to relapse was 8 months (95% confidence interval 7, 9 mos). CONCLUSION IV-MPPT, even early in the course of disease, did not affect long-term outcome of alopecia areata in our group of severely affected patients.
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Affiliation(s)
- Alexandra Smith
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ralph M Trüeb
- Center for Dermatology and Hair Diseases Professor Trüeb, Wallisellen, Switzerland
| | - Martin Theiler
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Valérie Hauser
- Pediatric Dermatology, Ostschweizer Children's Hospital, St. Gallen, Switzerland
| | - Lisa Weibel
- Department of Pediatric Dermatology, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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Calogiuri G, Nettis E, Di Leo E, Muratore L, Ferrannini A, Vacca A. Long-term selective IgE-mediated hypersensitivity to hydrocortisone sodium succinate. Allergol Immunopathol (Madr) 2013; 41:206-8. [PMID: 22999788 DOI: 10.1016/j.aller.2012.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 02/12/2012] [Accepted: 02/18/2012] [Indexed: 10/27/2022]
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Jang EJ, Jin HJ, Nam YH, Kim JH, Ye YM, Park HS. Acute urticaria induced by oral methylprednisolone. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:277-9. [PMID: 21966609 PMCID: PMC3178827 DOI: 10.4168/aair.2011.3.4.277] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 07/01/2011] [Indexed: 11/20/2022]
Abstract
Although corticosteroids have immunosuppressive, anti-inflammatory, and anti-allergic effects, allergic reactions are rare. We report a case involving a 52-year-old-female with acute urticaria caused by oral methylprednisolone. The patient had experienced aspirin-exacerbated respiratory disease (AERD) for 13 years with frequent asthma exacerbations. Symptoms of asthma exacerbations improved with short-term treatments of systemic steroids, including methylprednisolone or deflazacort, which had been well tolerated. However, the current admission was prompted by the development of acute generalized urticaria following the oral ingestion of methylprednisolone (8 mg) for relief of symptoms. An oral provocation test with 4 mg oral methylprednisolone led to generalized urticaria 20 minutes later, confirming the causal association. This is the first report of acute urticaria caused by oral methylprednisolone in a patient with AERD.
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Affiliation(s)
- Eun Jung Jang
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Sanfiorenzo C, Caimmi S, Galera C, Bousquet PJ, Demoly P. Réactions systémiques aux glucocorticoïdes. REVUE FRANCAISE D ALLERGOLOGIE 2010. [DOI: 10.1016/j.reval.2010.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Corbett SM, Rebuck JA. Medication-related complications in the trauma patient. J Intensive Care Med 2008; 23:91-108. [PMID: 18372349 DOI: 10.1177/0885066607312966] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma patients are twice as likely to have adverse reactions to medication as nontrauma patients. The need for medication in trauma patients is high. Surgery is often necessary, and immunosuppression and hypercoagulability may be present. Adverse drug events can be caused in part by altered pharmacokinetics, drug interactions, and polypharmacy. Medications may also have serious long-term adverse effects, which must be considered. It is not the purpose of this review article to discuss all adverse effects of all medications. This article will discuss the more common adverse effects of medications for trauma patients in the acute care setting, in the following categories: pain control, sedation, antibiotics, seizure prophylaxis in head trauma, atrial fibrillation, deep vein thrombosis and pulmonary embolism prophylaxis, hemodynamic support, adrenal insufficiency, factor VIIa.
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Doutre MS. Corticothérapie générale et urticaire : un serpent de mer. Ann Dermatol Venereol 2008; 135:7-8. [DOI: 10.1016/j.annder.2007.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 11/14/2007] [Indexed: 11/25/2022]
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Ventura MT, Calogiuri GF, Buquicchio R, Di Leo E, Ferrannini A. Cutaneous adverse drug reactions to Fluticasone propionate and Deflazacort in an asthmatic patient. Contact Dermatitis 2005; 53:118-9. [PMID: 16033410 DOI: 10.1111/j.0105-1873.2005.0650e.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M T Ventura
- Department of Internal Medicine, Immunology and Infectious Diseases (MIDIM), University of Bari Medical School, Policlinico, Bari, Italy.
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Abstract
PURPOSE OF REVIEW Hypersensitivity drug reactions are but one of the many different types of adverse drug reactions. They may be potentially life-threatening, prolong hospitalization, affect drug prescribing patterns of physicians and result in socioeconomic costs. This review summarizes current knowledge on the incidence, prevalence, mortality and risk factors for these reactions in different populations. RECENT FINDINGS Hypersensitivity reactions represent about one third of all adverse drug reactions. Adverse drug reactions affect 10-20% of hospitalized patients and more than 7% of the general population. Severe reactions including anaphylaxis, drug hypersensitivity syndromes, Stevens Johnson syndrome and toxic epidermal necrolysis are also associated with significant morbidity and mortality. Although several risk factors have been identified, their clinical importance has not been fully understood. Future progress in immunogenetics and pharmacogenetics may help identify populations at risk for specific types of reactions. SUMMARY Well designed epidemiological studies on hypersensitivity drug reactions are lacking as most studies have been on adverse drug reactions. Such studies will be helpful in identifying patients at risk of developing such reactions, in particular severe reactions, and implementing early preventive measures.
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Affiliation(s)
- Eva Rebelo Gomes
- Allergy Department, INSERM U454 - IFR3, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
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