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Jurado-Escobar R, Doña I, Perkins JR, Laguna JJ, Muñoz-Cano R, García-Sánchez A, Ayuso P, Torres MJ, Mayorga C, Cornejo-García JA. Polymorphisms in eicosanoid-related biosynthesis enzymes associated with acute urticaria/angioedema induced by nonsteroidal anti-inflammatory drug hypersensitivity. Br J Dermatol 2021; 185:815-824. [PMID: 33955560 DOI: 10.1111/bjd.20440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity, with NSAID-induced acute urticaria/angioedema (NIUA) the most frequent phenotype. NSAID hypersensitivity is caused by cyclooxygenase 1 inhibition, which leads to an imbalance in prostaglandin (PG) and cysteinyl leukotriene (CysLT) synthesis. As only susceptible individuals develop NSAID hypersensitivity, genetic factors are believed to be involved; however, no study has assessed the overall genetic variability of key enzymes in PG and CysLT synthesis in NSAID hypersensitivity. OBJECTIVES To evaluate simultaneously variants in the main genes involved in PG and CysLT biosynthesis in NIUA. METHODS Two independent cohorts of patients were recruited in Spain, alongside NSAID-tolerant controls. The discovery cohort included only patients with NIUA; the replication cohort included patients with NSAID-exacerbated respiratory disease (NERD). A set of tagging single-nucleotide polymorphisms (tagSNPs) in PTGS1, PTGS2, ALOX5 and LTC4S was genotyped using mass spectrometry coupled with endpoint polymerase chain reaction. RESULTS The study included 1272 individuals. Thirty-five tagSNPs were successfully genotyped in the discovery cohort, with three being significantly associated after Bonferroni correction (rs10306194 and rs1330344 in PTGS1; rs28395868 in ALOX5). These polymorphisms were genotyped in the replication cohort: rs10306194 and rs28395868 remained associated with NIUA, and rs28395868 was marginally associated with NERD. Odds ratios (ORs) in the combined analysis (discovery and replication NIUA populations) were 1·7 for rs10306194 [95% confidence interval (CI) 1·34-2·14; Pcorrected = 2·83 × 10-4 ) and 2·19 for rs28395868 (95% CI 1·43-3·36; Pcorrected = 0·002). CONCLUSIONS Variants of PTGS1 and ALOX5 may play a role in NIUA and NERD, supporting the proposed mechanisms of NSAID-hypersensitivity and shedding light on their genetic basis.
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Affiliation(s)
- R Jurado-Escobar
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Departments of, Department of, Medicine, University of Malaga, Malaga, Spain
| | - I Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain
| | - J R Perkins
- Department of, Molecular Biology and Biochemistry, University of Malaga, Malaga, Spain.,CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,The Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - J J Laguna
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Alergia, Hospital Central de la Cruz Roja, Madrid, Spain
| | - R Muñoz-Cano
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Allergy Section, Pneumology Department, Hospital Clinic, Universitat de Barcelona, ARADyAL, Barcelona, Spain
| | - A García-Sánchez
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Biochemistry, Pharmacogenetics Unit, University Hospital of Salamanca, Salamanca, Spain
| | - P Ayuso
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Department of Pharmacology, University of Extremadura, Caceres, Spain
| | - M J Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Departments of, Department of, Medicine, University of Malaga, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| | - C Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| | - J A Cornejo-García
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain
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2
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Rivera-Reigada ML, Moreno E, Sanz C, García-Sánchez A, Cornejo-García JA, Dávila I, Isidoro-García M. Atopy Can Be an Interfering Factor in Genetic Association Studies of ß-Lactam Allergy. J Investig Allergol Clin Immunol 2019; 30:63-65. [PMID: 31530517 DOI: 10.18176/jiaci.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M L Rivera-Reigada
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain
| | - E Moreno
- Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain.,Department of Allergy, University Hospital of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Madrid, Spain
| | - C Sanz
- Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain.,Department of Microbiology and Genetics. University of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Madrid, Spain
| | - A García-Sánchez
- Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Madrid, Spain
| | - J A Cornejo-García
- Asthma, Allergic and Adverse reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Madrid, Spain.,Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - I Dávila
- Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain.,Department of Allergy, University Hospital of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain
| | - M Isidoro-García
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain.,Biomedical Research Institute of Salamanca, IBSAL, Salamanca, Spain.,Department of Medicine, University Hospital of Salamanca, Salamanca, Spain.,Asthma, Allergic and Adverse reactions (ARADyAL) Network for Cooperative Research in Health of Instituto de Salud Carlos III, Madrid, Spain
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3
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Jurado-Escobar R, Perkins JR, García-Martín E, Isidoro-García M, Doña I, Torres MJ, Cornejo-García JA. Update on the Genetic Basis of Drug Hypersensitivity Reactions. J Investig Allergol Clin Immunol 2019; 27:336-345. [PMID: 29199960 DOI: 10.18176/jiaci.0199] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Drug hypersensitivity reactions (DHRs) are unpredictable, complex responses to medicines in predisposed individuals. They represent a major health problem owing to the number of patients affected and the severity of the clinical conditions they can induce. In addition to environmental factors, the underlying mechanisms of DHRs are also influenced by genetic factors, although considerable gaps remain in our knowledge. Therefore, further study of the genetics of DHRs is necessary to shed light on their underlying mechanisms. In this manuscript, we provide an update on the genetic basis of the most frequent types of DHRs, including those mediated by immunological and nonimmunological mechanisms. For the first group, we will focus on immediate reactions to β-lactam antibiotics, which are associated mainly with the IgE pathway (IL13, IL4R, LGALS3, and NOD2) and antigen presentation (HLA-DRA), and nonimmediate reactions to allopurinol, anticonvulsants, antibiotics, and antiretrovirals, which are often associated with polymorphisms in the HLA system. For the second group, we will focus on nonsteroidal anti-inflammatory drugs, which are mostly associated with genetic variants in enzymes and receptors from the arachidonic acid pathway (eg, ALOX5, ALOX5AP, PTGDR, and CYSLTR1). The information provided here will be of interest for medical practitioners from a range of disciplines who come across these reactions in their clinical practice, as well as for allergologists.
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Affiliation(s)
- R Jurado-Escobar
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - J R Perkins
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - E García-Martín
- Department of Pharmacology, University of Extremadura, Caceres, Spain
| | - M Isidoro-García
- Department of Clinical Biochemistry, Pharmacogenetics Unit, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Allergy Department, Salamanca, Spain.,Department of Medicine, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - I Doña
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - J A Cornejo-García
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain.,Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
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4
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San Segundo-Val I, García-Sánchez A, Sanz C, Cornejo-García JA, Isidoro-García M, Dávila I. Promoter Genotyping and mRNA Expression - Based Analysis of the PTGDR Gene in Allergy. J Investig Allergol Clin Immunol 2019; 30:117-126. [PMID: 31062691 DOI: 10.18176/jiaci.0411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Prostaglandin D2 receptors are acquiring a relevant role as potential therapeutic targets in allergy. PTGDR has been described as a candidate gene in allergic disease, although functional studies on this gene are lacking. Objective: The objective of this case-control study was to investigate the potential role of PTGDR in allergy. METHODS The study population comprised 195 allergic patients and 112 healthy controls. The PTGDR promoter polymorphisms -1289G>A, -1122T>C, -881C>T, -834C>T, -613C>T, -549T>C, -441C>T, -197T>C, and -95G>T were amplified by polymerase chain reaction (PCR) and sequenced. PTGDR expression levels were analyzed using quantitative PCR and normalized to GAPDH and TBP mRNA levels. All procedures were performed following the Minimum Information for Publication of Quantitative Real-Time PCR Experiment guidelines. RESULTS PTGDR expression levels were significantly higher in allergic patients than in controls (P<.001). Receiver operating characteristic analysis for expression of PTGDR showed a sensitivity of 81.4% compared with 67% for IgE levels. In addition, differences in the genotypic distribution of the polymorphisms -1289G>A and -1122T>C were found in allergic patients (P=.009). CONCLUSIONS The results indicate that PTGDR overexpression is associated with allergy. The polymorphisms -1289G>A and -1122T>C partly explain the variation in expression we observed. PTGDR expression could have a potential role as a biomarker and pharmacogenetic factor in allergy.
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Affiliation(s)
- I San Segundo-Val
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain
| | - A García-Sánchez
- Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain
| | - C Sanz
- Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Microbiology and Genetics, University of Salamanca, Salamanca, Spain
| | - J A Cornejo-García
- Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M Isidoro-García
- Department of Clinical Biochemistry, University Hospital of Salamanca, Salamanca, Spain.,Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Medicine, University of Salamanca, Salamanca, Spain
| | - I Dávila
- Institute for Biomedical Research of Salamanca, Salamanca, Spain.,Department of Biomedical Sciences and Diagnostics, University of Salamanca, Salamanca, Spain.,Department of Allergy, University Hospital of Salamanca, Salamanca, Spain
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5
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Doña I, Barrionuevo E, Salas M, Cornejo-García JA, Perkins JR, Bogas G, Prieto A, Torres MJ. Natural evolution in patients with nonsteroidal anti-inflammatory drug-induced urticaria/angioedema. Allergy 2017; 72:1346-1355. [PMID: 28226401 DOI: 10.1111/all.13147] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent triggers of drug hypersensitivity with NSAIDs-induced urticaria/angioedema (NIUA) the most common phenotype. Loss of hypersensitivity has been reported for IgE-mediated reactions; however, it has not been assessed in nonimmunological reactions such as NIUA. We evaluated NSAID-hypersensitivity over time in NIUA patients. METHODS Patients confirmed as NIUA by positive drug provocation test (DPT) with acetylsalicylic acid (ASA) during 2005-2012 (V1) were included (n=38). Subjects were prospectively re-evaluated by DPT with ASA/other NSAIDs at two time points between 2013 and 2015 (V2 and V3). Atopy was assessed by skin prick test (SPT) using inhalant and food allergens. RESULTS Patients were evaluated at V1 and re-evaluated after 60 months (V2; IR:48-81) and a further 18 months (V3; IR:14-24). At V2, the majority (24; 63.15%) tolerated ASA and other NSAIDs (Group A) while 14 (36.84%) still reacted (Group B). At V3, all Group A patients remained tolerant; all Group B patients remained hypersensitive. The number of previous episodes reported at V1 and the percentage of reactions induced by ASA/ibuprofen were significantly lower in Group A (P=.005 and P=.006, respectively). Group A patients developed tolerance 72 months (IR:45-87) after their last evaluated reaction (V1); this interval was shorter in nonatopics (P=.003), patients who experienced reactions over 1 hour after NSAIDs administration (P=.001), and those who experienced isolated urticaria after NSAID intake (P=.024). CONCLUSIONS NIUA patients may develop tolerance to NSAIDs over time, a process that seems to be influenced by atopy and type of clinical reaction.
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Affiliation(s)
- I. Doña
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - E. Barrionuevo
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - M. Salas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - J. A. Cornejo-García
- Research Laboratory; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
| | - J. R. Perkins
- Research Laboratory; IBIMA-Regional University Hospital of Malaga-UMA; Malaga Spain
| | - G. Bogas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - A. Prieto
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; Malaga Spain
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6
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Pérez-Alzate D, Cornejo-García JA, Pérez-Sánchez N, Andreu I, García-Moral A, Agúndez JA, Bartra J, Doña I, Torres MJ, Blanca M, Blanca-López N, Canto G. Immediate Reactions to More Than 1 NSAID Must Not Be Considered Cross-Hypersensitivity Unless Tolerance to ASA Is Verified. J Investig Allergol Clin Immunol 2017; 27:32-39. [PMID: 28211343 DOI: 10.18176/jiaci.0080] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Individuals who develop drug hypersensitivity reactions (DHRs) to chemically unrelated nonsteroidal anti-inflammatory drugs (NSAIDs) are considered cross-hypersensitive. The hallmark for this classification is that the patient presents a reaction after intake of or challenge with acetylsalicylic acid (ASA). Whether patients react to 2 or more NSAIDs while tolerating ASA remains to be studied (selective reactions, SRs). Objective: To identify patients with SRs to 2 or more NSAIDs including strong COX-1 inhibitors. METHODS Patients who attended the Allergy Service of Hospital Infanta Leonor, Madrid, Spain with DHRs to NSAIDs between January 2011 and December 2014 were evaluated. Those with 2 or more immediate reactions occurring in less than 1 hour after intake were included. After confirming tolerance to ASA, the selectivity of the response to 2 or more NSAIDs was demonstrated by in vivo and/or in vitro testing or by controlled administration. RESULTS From a total of 203 patients with immediate DHRs to NSAIDs, 16 (7.9%) met the inclusion criteria. The patients presented a total of 68 anaphylactic or cutaneous reactions (mean [SD], 4.2 [2.1]). Most reactions were to ibuprofen and other arylpropionic acid derivatives and to metamizole. Two different NSAIDs were involved in 11 patients and 3 in 5 patients. CONCLUSIONS Patients with NSAID-induced anaphylaxis or urticaria/angioedema should not be considered cross-hypersensitive unless tolerance to ASA is verified.
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Affiliation(s)
- D Pérez-Alzate
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - J A Cornejo-García
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain.,Research Laboratory, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - N Pérez-Sánchez
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - I Andreu
- Chemical Technology Institute, UPV-CSIC, Polytechnic University of Valencia, Valencia, Spain
| | - A García-Moral
- Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain
| | - J A Agúndez
- Department of Pharmacology, University of Extremadura, Caceres, Spain
| | - J Bartra
- Allergy Unit, Pneumology and Allergy Service, Clinic Hospital, Barcelona, Spain
| | - I Doña
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - M J Torres
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - M Blanca
- Allergy Unit, Malaga Regional University Hospital-IBIMA, UMA, Malaga, Spain
| | - N Blanca-López
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
| | - G Canto
- Allergy Service, Infanta Leonor University Hospital, Madrid, Spain
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Bogas G, Pérez-Sánchez N, Andreu I, Doña I, Perkins JR, Blanca M, Canto G, Cornejo-García JA, Blanca-López N. Anaphylaxis to 2 NSAIDs in a Patient Who Tolerated ASA. J Investig Allergol Clin Immunol 2016; 26:266-8. [DOI: 10.18176/jiaci.0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Cornejo-García JA, Jurado-Escobar R, Doña I, Doña JR, Agúndez JA, García-Martín E, Viguera E, Blanca-López N, Canto G, Blanca M. The Genetics of Drug Hypersensitivity Reactions. J Investig Allergol Clin Immunol 2016; 26:222-32, quiz next two pages. [DOI: 10.18176/jiaci.0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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9
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Blanca-López N, Pérez-Alzate D, Andreu I, Doña I, Agúndez JA, García-Martín E, Salas M, Miranda MÁ, Torres MJ, Cornejo-García JA, Blanca M, Canto G. Immediate hypersensitivity reactions to ibuprofen and other arylpropionic acid derivatives. Allergy 2016; 71:1048-56. [PMID: 26841325 DOI: 10.1111/all.12855] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although ibuprofen and other arylpropionic acid derivatives (APs) are the most common medicines involved in hypersensitivity drug reactions (HDRs) to NSAIDs, no patient series studies have been performed regarding immediate selective reactions (SRs) to these drugs. OBJECTIVE To characterize patients with immediate selective HDRs to ibuprofen and other APs through clinical history and challenge. METHODS Subjects who developed an HDR to APs less than 1 h after drug intake were included. Tolerance to aspirin was assessed and challenge was performed with ibuprofen in all cases, and additionally with the culprit drug (if different) in those patients that tolerated ibuprofen. Serum tryptase levels and tryptase immunohistochemical staining in skin biopsies were also assessed in some patients with a positive DPT to ibuprofen. RESULTS From a total of 245 patients with a confirmed history of HDRs to APs, 17% were classified as selective immediate hypersensitivity reactors by both clinical history and challenge. A selective response to naproxen and dexketoprofen with tolerance to ibuprofen was found in 16 of 20 cases. Significant differences in serum tryptase levels were observed between 2 and 24 h in the 11 cases that were studied further. CONCLUSIONS Within the group of patients with HDRs to NSAIDs, APs can induce immediate SRs. Within this group, selective responses to a single drug or responders to several APs may exist, suggesting potential immunological cross-reactivity.
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Affiliation(s)
- N. Blanca-López
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - D. Pérez-Alzate
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - I. Andreu
- Chemical Technology Institute; UPV-CSIC; Polytechnic University of Valencia; Valencia Spain
| | - I. Doña
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - J. A. Agúndez
- Department of Pharmacology; University of Extremadura; Caceres Spain
| | - E. García-Martín
- Department of Pharmacology; University of Extremadura; Caceres Spain
| | - M. Salas
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - M. Á. Miranda
- Chemical Technology Institute; UPV-CSIC; Polytechnic University of Valencia; Valencia Spain
| | - M. J. Torres
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - J. A. Cornejo-García
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
- Research Laboratory; IBIMA; Malaga Regional University Hospital, UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; Malaga Regional University Hospital-IBIMA, UMA; Malaga Spain
| | - G. Canto
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
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10
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Blanca-López N, Bogas G, Doña I, Torres MJ, Blanca M, Cornejo-García JA, Canto G, Demir S, Olgac M, Unal D, Gelincik A, Colakoglu B, Buyukozturk S. ASA must be given to classify multiple NSAID-hypersensitivity patients as selective or cross-intolerant. Allergy 2016; 71:576-8. [PMID: 27003105 DOI: 10.1111/all.12823] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- N. Blanca-López
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - G. Bogas
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - I. Doña
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - J. A. Cornejo-García
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
- Research Laboratory; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - G. Canto
- Allergy Service; Infanta Leonor University Hospital; Madrid Spain
| | - S. Demir
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - M. Olgac
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - D. Unal
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - A. Gelincik
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - B. Colakoglu
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
| | - S. Buyukozturk
- Department of Allergy and Immunology; Division of Internal Medicine; Istanbul University; Istanbul Medical Faculty; Istanbul Turkey
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11
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Cornejo-García JA, Romano A, Guéant-Rodríguez RM, Oussalah A, Blanca-López N, Gaeta F, Tramoy D, Josse T, Doña I, Torres MJ, Canto G, Blanca M, Guéant JL. A non-synonymous polymorphism in galectin-3 lectin domain is associated with allergic reactions to beta-lactam antibiotics. Pharmacogenomics J 2015; 16:79-82. [PMID: 25869013 DOI: 10.1038/tpj.2015.24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/02/2015] [Accepted: 01/28/2015] [Indexed: 11/09/2022]
Abstract
Genetic predictors of beta-lactam (BL) allergy are mostly related to Immunoglobulin E (IgE) synthesis and atopy. Despite this context, little attention has been devoted to genes of IgE/FcɛRI pathway, such as galectin-3, a β-galactoside-binding lectin, which binds to IgE. We evaluated the association of LGALS3 polymorphisms with BL allergy in 395 Spanish and 198 Italian cases, compared with 310- and 339-matched controls, respectively. The rs11125 predicted BL allergy with an odds ratio of 4.0 in Spanish population (P<0.0001). This association was replicated with an odds ratio of 5.1 in Italian population (P<0.0001); rs11125 predicted also increased serum level of total IgE in Spanish controls. These data are consistent with the predicted deleterious influence of Gln>His substitution produced by rs11125 on galactose-binding activity of galectin-3. In conclusion, LGALS3 is the strongest genetic predictor of BL allergy reported so far. This association reflects the influence of genes of IgE/FcɛRI pathway in this pathology.
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Affiliation(s)
- J A Cornejo-García
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France.,Research Laboratory, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain.,Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - A Romano
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S., Troina, Italy
| | - R M Guéant-Rodríguez
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - A Oussalah
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | | | - F Gaeta
- Department of Internal Medicine and Geriatrics, UCSC-Allergy Unit, Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S., Troina, Italy
| | - D Tramoy
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - T Josse
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
| | - I Doña
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - G Canto
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain
| | - M Blanca
- Allergy Unit, IBIMA, Regional University Hospital of Malaga, UMA, Malaga, Spain
| | - J-L Guéant
- INSERM U-954, University of Lorraine and University Hospital Center (CHU) of Nancy, Nancy, France
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12
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Blanca-López N, Cornejo-García JA, Pérez-Alzate D, Pérez-Sánchez N, Plaza-Serón MC, Doña I, Torres MJ, Canto G, Kidon M, Perkins JR, Blanca M. Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Selective Reactions. J Investig Allergol Clin Immunol 2015; 25:385-395. [PMID: 26817135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used throughout the world to treat pain and inflammation; however, they can trigger several types of drug hypersensitivity reactions (DHRs) in all age groups. Although most such reactions occur through activation of the leukotriene pathway without specific immunological recognition (cross-intolerance), a significant number of DHRs to NSAIDs are due to immunological mechanisms (selective reactions [SRs]). SRs are thought to be induced by specific IgE antibodies or by T cells. In this manuscript, we focus on SRs, which are of great concern in children and adolescents and comprise a heterogeneous set of clinical pictures ranging from mild entities such as urticaria/angioedema to potentially life-threatening conditions such as Stevens-Johnson syndrome/toxic epidermal necrolysis. Paracetamol and ibuprofen are the most frequent elicitors of IgE-mediated SRs, although pyrazolones have also been implicated. T cell-mediated reactions are infrequent in children but have been associated with ibuprofen, naproxen, and dipyrone. In this review, we analyze the available literature on SRs in children and adolescents, with emphasis on epidemiological data, mechanisms, and drugs involved, as well as on diagnostic procedures.
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13
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Blanca-López N, Cornejo-García JA, Plaza-Serón MC, Doña I, Torres-Jaén MJ, Canto G, Padilla-España L, Kidon M, Perkins JR, Blanca M. Hypersensitivity to Nonsteroidal Anti-inflammatory Drugs in Children and Adolescents: Cross-Intolerance Reactions. J Investig Allergol Clin Immunol 2015; 25:259-269. [PMID: 26310040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used worldwide and are responsible for several types of drug hypersensitivity reactions (DHRs) in all age groups. The 2 major groups of DHRs to NSAIDs are those induced by immunological mechanisms (selective reactions) and those where inflammatory mediators are released through activation of the prostaglandin-leukotriene pathway without specific immunological recognition (cross-intolerance). In the present review, we focus on cross-intolerance reactions, which are the most frequent DHRs and are becoming a topic of major interest in children and adolescents. Paracetamol and ibuprofen are the drugs that most frequently cause DHRs in children; other NSAIDs are responsible for reactions in adolescents. In vivo and in vitro tests are of limited diagnostic value, with some exceptions for the less common selective reactions. In cross-intolerance, the clinical history and controlled administration are in many instances the only way to establish a diagnosis and look for alternatives. The clinical history is diagnostic when consistent symptoms occur repeatedly after exposure to NSAIDs with different chemical structures. Cutaneous and respiratory symptoms often co-occur in young children. The natural history of these reactions in children is unknown, and some patients can develop tolerance over time. Atopy remains a major risk factor for cross-intolerant reactions. The increasing interest in hypersensitivity to NSAIDs with improvements in patient phenotyping and the information provided by pharmacogenetics will improve our understanding and management of these reactions in the near future.
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Ayuso P, Blanca-López N, Doña I, Torres MJ, Guéant-Rodríguez RM, Canto G, Sanak M, Mayorga C, Guéant JL, Blanca M, Cornejo-García JA. Advanced phenotyping in hypersensitivity drug reactions to NSAIDs. Clin Exp Allergy 2014; 43:1097-109. [PMID: 24074328 DOI: 10.1111/cea.12140] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are the medications most frequently involved in hypersensitivity drug reactions. Because NSAIDs are prescribed for many conditions, this is a world-wide problem affecting patients of all ages. Various hypersensitivity reactions have been reported, mainly affecting the skin and/or the respiratory airways. The most frequent of these is acute urticaria, which can be induced by several different NSAIDs. Both specific and non-specific immunological pathways have been proposed as underlying mechanisms. This review presents the clinical phenotypes and the drugs involved in NSAID hypersensitivity. Five major clinical syndromes can be distinguished: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated cutaneous disease (AECD), multiple NSAID-induced urticaria/angioedema (MNSAID-UA), single NSAID-IgE reactions and single NSAID T cell responses. However, further classification is possible within these five major entities, by detailed descriptions of the clinical characteristics enabling more phenotypes to be defined. This detailed differentiation now seems required in order to undertake appropriate pharmacogenetic studies.
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Affiliation(s)
- P Ayuso
- Allergy Research Laboratory, Carlos Haya Hospital, Málaga, Spain
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15
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Doña I, Blanca-López N, Torres MJ, Gómez F, Fernández J, Zambonino MA, Monteseirín FJ, Canto G, Blanca M, Cornejo-García JA. NSAID-induced urticaria/angioedema does not evolve into chronic urticaria: a 12-year follow-up study. Allergy 2014; 69:438-44. [PMID: 24372026 DOI: 10.1111/all.12335] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most frequent medicaments involved in drug hypersensitivity reactions, with NSAID-induced urticaria/angioedema (NIUA) being the most frequent clinical entity. The natural evolution of NIUA has been suggested to lead to chronic urticaria (CU) in an important proportion of patients, such that NIUA may therefore precede CU. Our aim was to verify whether these entities are related by following up a large cohort of patients with NIUA as well as a control group over a long period of time. METHODS The study comprised three groups: (i) patients with a confirmed history of NIUA (more than two episodes with at least two different NSAIDs or positive drug provocation tests), (ii) patients with more than two episodes of urticaria/angioedema to a single NSAID with good tolerance to a strong COX-1 inhibitor and/or evidence by in vivo tests supporting specific IgE antibodies to the drug (single NSAID-induced urticaria/angioedema, SNIUA), and (iii) controls who tolerated NSAIDs. All cases in the three groups were followed up over a period of 12 years. RESULTS There were 190 patients with NIUA (64.6% female; mean age 43.71 ± 15.82 years, 110 with SNIUA, and 152 controls. At the 12-year evaluation, 12 patients with NIUA (6.15%) had developed CU over a 1- to 8-year period. Similar proportions were seen in SNIUA and controls. CONCLUSIONS Nonsteroidal anti-inflammatory drugs-induced urticaria/angioedema does not seem to precede the onset of CU over the medium term. Further research including a longer follow-up is necessary to verify this observation.
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Affiliation(s)
- I. Doña
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | | | - M. J. Torres
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | - F. Gómez
- Allergy Service; Carlos Haya Hospital; Malaga Spain
| | - J. Fernández
- Allergy Service; Elche General Hospital; Alicante Spain
| | | | | | - G. Canto
- Allergy Service; Infanta Leonor Hospital; Madrid Spain
| | - M. Blanca
- Allergy Service; Carlos Haya Hospital; Malaga Spain
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16
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Fernandez TD, Mayorga C, Guéant JL, Blanca M, Cornejo-García JA. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions. Allergy 2014; 69:150-8. [PMID: 24467839 DOI: 10.1111/all.12304] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 01/11/2023]
Abstract
Hypersensitivity drug reactions (HDRs) represent a large and important health problem, affecting many patients and leading to a variety of clinical entities, some of which can be life-threatening. The culprit drugs include commonly used medications including antibiotics and NSAIDs. Nontherapeutical agents, such as contrast media, are also involved. Because the pathophysiological mechanisms are not well known and the current diagnostic procedures are somewhat insufficient, new approaches are needed for understanding the complexity of HDRs. Histochemical and molecular biology studies have enabled us to classify these reactions more precisely. Pharmacogenetics has led to the identification of several genes, involved mainly in T-cell-dependent responses, with a number of markers being replicated in different studies. These markers are now being considered as potential targets for reducing the number of HDRs. Transcriptomic approaches have also been used to investigate HDRs by identifying genes that show different patterns of expression in a number of clinical entities. This information can be of value for further elucidation of the mechanisms involved. Although first studies were performed using RT-PCR analysis to monitor the acute phase of the reaction, nowadays high-density expression platforms represent a more integrative way for providing a complete view of gene expression. By combining a detailed and precise clinical description with information obtained by these approaches, we will obtain a better understanding and management of patients with HDRs.
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Affiliation(s)
- T. D. Fernandez
- Research Laboratory; Malaga General Hospital-IBIMA; Malaga Spain
| | - C. Mayorga
- Research Laboratory; Malaga General Hospital-IBIMA; Malaga Spain
| | - J. L. Guéant
- Faculty of Medicine; INSERM U-954; Nutrition-Génétique et exposition aux risques environmentaux; University of Nancy; Vandoeuvre-les-Nancy France
- University Hospital Center of Nancy; Vandoeuvre-les-Nancy France
| | - M. Blanca
- Allergy Service; Malaga General Hospital; Malaga Spain
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17
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Campo P, Ayuso P, Salas M, Plaza MC, Cornejo-García JA, Doña I, Torres MJ, Blanca-López N, Canto G, Guéant JL, Sanak M, Blanca M. Mediator release after nasal aspirin provocation supports different phenotypes in subjects with hypersensitivity reactions to NSAIDs. Allergy 2013; 68:1001-7. [PMID: 23889565 DOI: 10.1111/all.12187] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple NSAID-induced urticaria/angioedema (MNSAID-UA) is an entity well differentiated from aspirin-exacerbated respiratory disease (AERD), although no detailed phenotype analysis has yet been performed. The objective was to evaluate the functional characteristics of MNSAID-UA subjects by analyzing the response to nasal lysine-aspirin challenge and measurement of nasal inflammatory mediator release compared with AERD subjects and controls. METHODS The study included 85 subjects with confirmed hypersensitivity to NSAIDs (≥3 episodes with >2 different NSAIDs or positive drug provocation) with either cutaneous (MNSAID-UA, n = 25) or respiratory manifestations (AERD, n = 60) and 30 tolerant controls (15 aspirin-tolerant asthmatic patients and 15 healthy controls). Nasal lavages at 0, 15, 60, and 120 min after lysine-aspirin challenge were analyzed for ECP, tryptase, PGE2 , PGD2 , LTD4 , and LTE4 . RESULTS Lysine nasal challenge was positive in 80% of the AERD cases but positive only in 12% of the MNSAID-UA group. MNSAID-UA subjects showed no changes in nasal ECP, whereas subjects with AERD had increased levels of ECP, with the highest peak at 15 min after challenge (P < 0.05). Tryptase levels were higher in AERD compared with MNSAID-UA and controls with the highest release of tryptase at 60 min (P < 0.05). Significant increases in PGD2 , LTD4 , and LTE4 were observed in AERD (at 60 min for PGD2 , LTD4 , and LTE4 ) but not in MNSAID-UA or control subjects (P < 0.05). CONCLUSIONS Data support the observation that MNSAID-UA, although sharing a common response with AERD to COX inhibitors, seems to have a distinctive phenotype, based on the response to nasal challenge and the release of inflammatory mediators.
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Affiliation(s)
- P. Campo
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - P. Ayuso
- Allergy Research Laboratory; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. Salas
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. C. Plaza
- Allergy Research Laboratory; Carlos Haya Hospital, Málaga; Málaga; Spain
| | | | - I. Doña
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | - M. J. Torres
- Allergy Service; Carlos Haya Hospital, Málaga; Málaga; Spain
| | | | - G. Canto
- Allergy Service; Infanta Leonor Hospital; Madrid; Spain
| | - J.-L. Guéant
- Nutrition, Genetics and Environment; Faculty of Medicine; INSERM-U954; Vandoeuvre lès Nancy; France
| | - M. Sanak
- Division of Molecular Biology and Clinical Genetics; Department of Medicine; Jagiellonian University Medical College; Krakow; Poland
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18
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Cornejo-García JA, Jagemann LR, Blanca-López N, Doña I, Flores C, Guéant-Rodríguez RM, Torres MJ, Fernández J, Laguna JJ, Rosado A, Agúndez JAG, García-Martín E, Canto G, Guéant JL, Blanca M. Genetic variants of the arachidonic acid pathway in non-steroidal anti-inflammatory drug-induced acute urticaria. Clin Exp Allergy 2013. [PMID: 23181793 DOI: 10.1111/j.1365-2222.2012.04078.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND To date, genetic studies of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) have been carried out mainly in aspirin-induced asthma and to a lesser extent in chronic urticaria, with no studies in patients with acute urticaria (AU), the most common entity induced by these drugs. OBJECTIVE In this work, we analysed the association of common variants of 15 relevant genes encoding both enzymes and receptors from the arachidonic acid (AA) pathway with NSAID-induced AU. METHODS Patients were recruited in several Allergy Services that are integrated into the Spanish network RIRAAF, and diagnosed of AU induced by cross-intolerance (CRI) to NSAIDs. Genotyping was carried out by TaqMan allelic discrimination assays. RESULTS A total of 486 patients with AU induced by CRI to NSAIDs and 536 unrelated controls were included in this large Spanish case-control study. Seven variants from 31 tested in six genes were associated in a discovery study population from Malaga (0.0003 ≤ p-value ≤ 0.041). A follow-up analysis in an independent sample from Madrid replicated three of the SNPs from the ALOX15 (rs7220870), PTGDR (rs8004654) and CYSLTR1 (rs320095) genes (1.055x10(-6) ≤meta-analysis p-value ≤ 0.003). CONCLUSIONS AND CLINICAL RELEVANCE Genetic variants of the AA pathway may play an important role in NSAID-induced AU. These data may help understand the mechanism underlying this disease.
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Affiliation(s)
- J A Cornejo-García
- INSERM U-954, Nutrition-Génétique et exposition aux risques environmentaux, Faculty of Medicine, University of Nancy, Vandoeuvre-les-Nancy, France.
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Cornejo-García JA, Guéant-Rodriguez RM, Torres MJ, Blanca-Lopez N, Tramoy D, Romano A, Blanca M, Guéant JL. Biological and genetic determinants of atopy are predictors of immediate-type allergy to betalactams, in Spain. Allergy 2012; 67:1181-5. [PMID: 22764749 DOI: 10.1111/j.1398-9995.2012.02867.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Betalactam (BL) immediate-type allergy is influenced by environmental and genetic determinants, as illustrated by differences in worldwide prevalence and ethnicity from a same area and by associations with genes related to atopy. AIMS To evaluate the association of atopy with BL allergy. MATERIALS AND METHODS We measured specific Immunoglobulin E (IgE) against prevalent allergens and genetic predictors of atopy, IL13, IL4, IL4RA, IL4, and TNFA, in 340 patients and 340 controls from South of Spain. RESULTS Total IgE and IgE against mites were at higher concentration in patients. Patients with high total IgE and IgE against prevalent allergens had a slower decrease in BL IgE than nonatopic patients. IL4RA I50V and Q551R were associated with IgE against prevalent allergens and total IgE, respectively, and were also predictors of BL allergy. CONCLUSION Interacting determinants of atopy, total IgE, IgE against prevalent allergens, and IL4RA polymorphisms, contribute to the high prevalence of BL allergy in South of Spain.
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Affiliation(s)
| | - R.-M. Guéant-Rodriguez
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
| | - M. J. Torres
- Servicio de Alergia; Hospital Carlos Haya; Málaga; Spain
| | - N. Blanca-Lopez
- Laboratorio de Investigación; Hospital Carlos Haya-Fundación IMABIS; Málaga; Spain
| | - D. Tramoy
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
| | - A. Romano
- Unità di Allergologia; Complesso Integrato Columbus; Rome; Italy
| | | | - J.-L. Guéant
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
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Doña I, Blanca-López N, Cornejo-García JA, Torres MJ, Laguna JJ, Fernández J, Rosado A, Rondón C, Campo P, Agúndez JA, Blanca M, Canto G. Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: patterns of response. Clin Exp Allergy 2011; 41:86-95. [PMID: 21155908 DOI: 10.1111/j.1365-2222.2010.03651.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently involved groups of medicines in hypersensitivity drug reactions. Two mechanisms can induce the reaction: immunological (sensitization) due to a specific IgE or T cell response and pharmacological (cyclooxygenase inhibition). The contribution of each of these mechanisms to the reactions is not well known. OBJECTIVE To analyse a large group of subjects with confirmed hypersensitivity reactions to NSAIDs. METHODS The drugs involved, the clinical entities induced and the time interval between drug intake and appearance of the reaction were studied. In cases where the diagnosis was not confirmed, a drug provocation test was carried out. Atopy status was also assessed with prick test and total IgE in serum. RESULTS A total of 659 patients were finally considered to have had hypersensitivity reactions to NSAIDs; 76% had cross-intolerance (CI) and 24% were selective responders (SR). The most important drugs involved in CI were propionic acid derivatives, in most cases ibuprofen, and in SR pyrazolones. In CI, the most frequent clinical entity was urticaria and angio-oedema and to a lesser extent airway involvement. The skin and airways were both involved in an important proportion of cases. The most frequent entities in SR were urticaria and/or angio-oedema followed by anaphylaxis. Atopy was significantly associated in the CI group (P<0.005). CONCLUSION AND CLINICAL RELEVANCE Cutaneous hypersensitivity reactions by CI to NSAIDs are the most frequent entities induced by these compounds. In addition to aspirin, other NSAIDs are taking on a predominant role. Atopy can be a predisposing factor in patients with CI.
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Affiliation(s)
- I Doña
- Allergy Service, Carlos Haya Hospital (Pabellon C), Málaga, Spain
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21
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Antúnez C, Martín E, Cornejo-García JA, Blanca-Lopez N, R-Pena R, Mayorga C, Torres MJ, Blanca M. Immediate Hypersensitivity Reactions to Penicillins and Other Betalactams. Curr Pharm Des 2006; 12:3327-33. [PMID: 17017927 DOI: 10.2174/138161206778194042] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Immediate hypersensitivity reactions to betalactams are IgE mediated and constitute the most frequent allergic reactions mediated by specific immunological mechanisms. IgE responses to benzyl penicillin (BP), the first antibiotic producing the benzyl penicilloyl structure (BPO), are characterized by a quick release of inflammatory mediators, resulting in anaphylactic shock, urticaria and angioedema. With the progressive appearance of other structures, comprising cephalosporins, carbapenems, monobactams and clavulanic acid, IgE selective responses and cross-reactivity reactions were observed. The diagnosis of betalactam hypersensitivity, classically based on skin testing with major and minor determinants of benzyl penicillin or in vitro IgE antibodies to BP, has been modified by the inclusion of different determinants generated from these compounds, for which amoxicillin (AX) is the most relevant, followed by cephalosporins. Some subjects develop positive responses to several betalactams, mostly within the same family, but others develop a selective response. These are relevant for the appropriate selection of antimicrobial drugs in patients who have immediate hypersensitivity to betalactams.
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Affiliation(s)
- C Antúnez
- Research Unit for Allergic Diseases, Carlos Haya Hospital, Málaga, Spain
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22
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Torres MJ, Mayorga C, Fernández TD, Cornejo-García JA, Antúnez C, Valenzuela M, Del Prado MF, Rodriguez-Pena R, Blanca M. T cell assessment in allergic drug reactions during the acute phase according to the time of occurrence. Int J Immunopathol Pharmacol 2006; 19:119-30. [PMID: 16569350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023] Open
Abstract
Allergic drug reactions can be classified as immediate, accelerated or delayed. This classification usually correlates with the mechanism involved: immediate reactions are IgE mediated and delayed reactions are T cell dependent. We analyzed lymphocyte involvement in patients with these reactions by determining cell subpopulations, activation state and skin homing receptor expression (CLA) in blood and skin. Patients with immediate, accelerated and delayed reactions were evaluated during the acute phase and after resolution. Controls taking drugs were included. Phenotypic immunofluorescence analysis was done by flow cytometry in peripheral blood, and by immunohistochemistry in skin for delayed reactions. Forty-six patients were included, 17 with immediate reactions, 10 accelerated and 19 delayed. At the acute phase CLA was significantly increased in delayed reactions and HLA-DR in all three types of reaction. In the severest delayed reactions, Steven-Johnson/Lyell syndromes, the CD4 subsets were increased in peripheral blood and skin compared to maculopapular exanthemas and urticaria and HLA-DR when compared with urticaria. In maculopapular exanthemas CLA was significantly increased in peripheral blood and skin compared to urticaria and the severe reactions. We found that T-cells are implicated, besides delayed reactions, in immediate and accelerated reactions. In delayed reactions there is a parallelism between results found in skin and peripheral blood with a higher participation of CD4+ cells the more severe the reaction.
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Affiliation(s)
- M J Torres
- Allergy Service, Carlos Haya Hospital, 29009 Malaga, Spain.
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Torres MJ, Padial A, Mayorga C, Fernández T, Sanchez-Sabate E, Cornejo-García JA, Antúnez C, Blanca M. The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams. Clin Exp Allergy 2004; 34:1768-75. [PMID: 15544603 DOI: 10.1111/j.1365-2222.2004.02110.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Basophil activation by allergens, including drugs, has been used to determine sensitivity and to study IgE recognition and cross-reactivity. OBJECTIVE We sought to determine the sensitivity and specificity of a basophil activation test (Basotest) in patients with immediate allergic reactions to betalactams, with a later comparison between patients who were selective (those recognizing the culprit drug excluding benzylpenicillin (BP)) and cross-reactors (those recognizing several penicillin determinants including BP). METHODS Basotest to different haptens was performed in 70 patients with immediate allergic reactions to betalactams, classified into three groups: (A) skin test positive independently of CAP/RAST immunoassay value, (B) skin test negative and CAP/RAST positive, and (C) skin test and CAP/RAST negative but drug provocation test positive. Basotest was carried out by flow cytometry following the manufacturer's instructions using different betalactam determinants and results expressed as a stimulation index. RESULTS Of the 70 patients, 34 (48.6%) were positive to Basotest (sensitivity: 48.6%), 31 (44.3%) to CAP/RAST and 46 (65.7%) to either one or the other. Considering the different groups, Basotest was positive in 50.9% of patients in Group A, 60% in Group B and 14.3% in Group C. The specificity was 91.3%. Positivity to the haptens was 28.6% to amoxicillin (AX), 21.7% to BP, 20% to benzylpenicilloyl-poly-l-lysine, 12.5% to ampicillin and 2.2% to minor determinant mixture. In patients with cephalosporin reactions, Basotest to the culprit cephalosporin was positive in 77.7%. There were differences between the two reactor groups in the sensitivity of Basotest (selective to AX=50%, cross-reactors=28.6%; chi(2)=10.809, P=0.004) and in the CAP/RAST (selective to AX=28.6%, cross-reactors=61.9%; chi(2)=8.944, P=0.011). CONCLUSIONS The sensitivity of Basotest is similar to immunoassays (CAP/RAST). Sensitivity is improved when used in combination. Although further studies are required, Basotest results for cephalosporin allergy seem very promising. This technique does not help differentiate between selective reactors and cross-reactors.
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Affiliation(s)
- M J Torres
- Research Unit for Allergic Diseases, Allergy Service, Carlos Haya Hospital, Málaga, Spain.
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Antúnez C, Torres MJ, Mayorga C, Cornejo-García JA, Santamaría-Babi LF, Blanca M. Different cytokine production and activation marker profiles in circulating cutaneous-lymphocyte-associated antigen+ T cells from patients with acute or chronic atopic dermatitis. Clin Exp Allergy 2004; 34:559-66. [PMID: 15080808 DOI: 10.1111/j.1365-2222.2004.1933.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is an inflammatory skin disease whose lesions can have two stages: acute and chronic. In skin biopsies a biphasic pattern of cytokine expression has been shown, Th2 in acute lesions and Th1 in chronic AD lesions. OBJECTIVE We investigated the expression of an activation marker and a homing receptor, as well as cytokine production, in different peripheral blood T cell subpopulations from AD patients with chronic (Group A) and acute lesions (Group B) and controls. METHODS We evaluated 26 adult AD patients (12 Group A, 14 Group B) and 14 non-atopic controls. IgE was measured by immunoassay. CD4, CD8, cutaneous-lymphocyte-associated antigen (CLA) and human leucocyte antigen (HLA)-DR expression, and cytokine production (IL-2, IL-13, IFN-gamma, TNF-alpha, IL-10, IL-4) were analysed in mononuclear cells by flow cytometry. RESULTS In Group B there was a significant increase in eosinophil levels and a non-significant increase in IgE. In Group A we found an increase in CLA(+)CD4(+) cells (8.19+/-1.84) compared with controls (4.83+/-0.53) (P<0.05) and CD4(+)HLA-DR(+) cells in the CLA(+) subpopulation (45.54+/-15.40) compared with controls (30.49+/-6.07) (P<0.05). In the CLA(+)CD4(+) subpopulation, there was a significant increase in IL-4, IL-13 and TNF-alpha production in Group B (12.46+/-7.7, 11.26+/-5.97, 43.92+/-15.55) compared with controls (5.34+/-3.50, 4.54+/-1.78, 19.29+/-9.97) with no differences in Group A. CONCLUSION Greater immunological differences were detected in peripheral blood from patients with acute compared with chronic lesions, especially in the circulating T cell-subset with skin tropism that preferentially responded to cutaneous allergens. This is the first demonstration of phenotypic changes in circulating CLA(+) T cells between AD patients with acute and chronic lesions.
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Affiliation(s)
- C Antúnez
- Research Unit for Allergic Diseases, Allergy Service, Carlos Haya Hospital, Malaga, Spain
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Affiliation(s)
- M J Torres
- Servicio de Alergia, Hospital Universitario La Paz, Paseo de La Castellana 2612, 8046 Madrid, Spain.
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Torres MJ, Mayorga C, Leyva L, Guzman AE, Cornejo-García JA, Juarez C, Blanca M. Controlled administration of penicillin to patients with a positive history but negative skin and specific serum IgE tests. Clin Exp Allergy 2002; 32:270-6. [PMID: 11929493 DOI: 10.1046/j.1365-2222.2002.01296.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although subjects with a positive history of immediate allergy to penicillin and negative skin test are traditionally considered to tolerate penicillin, current evidence indicates that they may develop an immediate reaction despite negative skin and serum specific IgE tests. It is thought that these patients require additional tests to confirm the diagnosis. OBJECTIVE To assess in a large group of patients with a history of immediate allergy to penicillins but with both skin test and CAP-FEIA-negative to classical and side chain penicillin determinants, the role of controlled administration of betalactams as a diagnostic test. METHODS A group of 330 patients with a history of immediate allergic reactions to penicillins was studied by two evaluators from the same allergy unit using the following protocol: skin tests with major and minor determinants of benzylpenicillin (benzylpenicilloyl-poly l-lysine and minor determinant mixture), amoxicillin and ampicillin, and determination of specific IgE antibodies to penicillins, by CAP-FEIA, in serum. If both tests proved negative, a controlled administration of the drug was then carried out. RESULTS A total of 89 (27%) patients were skin test and CAP-FEIA-negative and therefore required controlled administration of the drug. Of these, 49 developed an immediate response and were therefore considered allergic, and the remainder had good tolerance after administration of both benzylpenicillin and amoxicillin. The clinical characteristics of this group were similar to the other allergic patients who were skin test or CAP-FEIA-positive, except that they were younger (P < 0.01). Twenty-two (45%) developed a response to benzylpenicillin and 27 (55%) had a selective response to amoxicillin. Although all reactions appeared within 1 h, a positive correlation was found between the dose inducing the response and the time elapsed from drug administration, for both benzylpenicillin and amoxicillin (P < 0.001). CONCLUSION These data indicate that an important number of subjects are not correctly identified if only skin tests and/or CAP-FEIA are used and that this is particularly relevant for side chain-specific reactions and younger subjects. This suggests that new diagnostic tests are required so as to limit the use of controlled administration.
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Affiliation(s)
- M J Torres
- Research Unit for Allergic Diseases, Carlos Haya Hospital, Malaga, Spain
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Corzo JL, Garcia-Martin FJ, Vera V, Mayorga C, Torres MJ, Gonzalez L, Cornejo-García JA, Jurado A, Blanca M. Toxic epidermal necrolysis induced by lamotrigine in a child: Rapid recovery after high dose intravenous immunoglobin treatment. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81580-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Posadas S, Torres MJ, Leyva L, Mayorga C, Cornejo-García JA, Sanchez E, Bellon T, Fernandez J, Blanca M. Cytokine profiles and cytotoxic markers in toxic epidermal necrolysis treated with and without corticoids. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)81582-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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