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Sutton KM, Watts MR, Athavale DD, Lewis N, Petsoglou C, Hudson BJ, Fernando SL. Case Report: The Use of In Vivo Confocal Microscopy for Diagnosis and Monitoring in a Rare Case of Ancaliia algerae Microsporidial Keratitis in New South Wales, Australia. Am J Trop Med Hyg 2024; 110:87-89. [PMID: 37983904 DOI: 10.4269/ajtmh.23-0474] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/15/2023] [Indexed: 11/22/2023] Open
Abstract
We describe the successful management of Ancaliia Algerae microsporidial keratitis in an immunosuppressed 54-year-old woman with refractory linear IgA disease. The case highlights the challenges in diagnosis and management of this infection in immunocompromised individuals and emphasizes the usefulness of in vivo confocal microscopy as a novel, noninvasive tool to aid in the diagnosis and monitoring of microsporidial keratitis. We also discuss the possible mode of acquisition of this rare infection.
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Affiliation(s)
- Kathryn M Sutton
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Matthew R Watts
- Centre for Infectious Diseases and Microbiology Public Health, Westmead, Australia
- Institute for Clinical Pathology and Medical Research-New South Wales Health Pathology, Westmead, Australia
- University of Sydney, Sydney, Australia
| | - Daniel D Athavale
- Department of Ophthalmology, Royal North Shore Hospital, Sydney, Australia
| | - Noni Lewis
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
| | - Constantinos Petsoglou
- University of Sydney, Sydney, Australia
- Department of Ophthalmology, Sydney Eye Hospital, Sydney, Australia
| | - Bernard J Hudson
- University of Sydney, Sydney, Australia
- Department of Clinical Microbiology and Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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2
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Weir C, Sung-In Jang H, Fernando SL. The role of lymphocyte transformation tests (LTT) in suspected severe delayed hypersensitivity reactions following COVID-19 vaccination. Hum Vaccin Immunother 2023; 19:2182527. [PMID: 36912718 PMCID: PMC10054271 DOI: 10.1080/21645515.2023.2182527] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 03/14/2023] Open
Abstract
Coronavirus (COVID-19) vaccines have proved to be effective in the pandemic response but can cause adverse events such as delayed hypersensitivity reactions (DHRs). Delayed-reading intradermal tests (IDT) to vaccines are limited by false-positive results and may reflect a cell-mediated rather than IgE-mediated immune response. Lymphocyte transformation test (LTT), which has been utilized in the diagnosis of drug allergy, may be helpful in suspected COVID-19 vaccine and/or its excipient-related DHRs. To investigate the use of LTT in two suspected cases of COVID-19 vaccine-induced DHRs, two patients with suspected DHRs to COVID-19 vaccination were tested by delayed-reading IDT and LTT against vaccines and their excipients. A 47-year-old man developed acute mixed-pattern hepatitis after the second dose of ChAdOx1 vaccine. LTT performed at 2 months post-vaccination revealed reactivity to the ChAdOx1 vaccine, polysorbate 80 and mildly to PEG 2050 but not BNT162b2 vaccine. Delayed-reading IDT returned negative to both vaccines and excipients. He tolerated BNT162b2 vaccination with no adverse events. A 36-year-old woman presented with subacute morbilliform eruption and hepatitis after the first dose of BNT162b2 vaccine. LTT performed 3 months later revealed reactivity to the BNT162b2 but not PEG 2050. Repeat LTT following subsequent natural Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) infection revealed reactivity to ChAdOx1 and NVX-CoV2373 vaccines but not polysorbate 80. Delayed-reading IDT remained negative. She proceeded with NVX-CoV2373 vaccination with no symptom recurrence. LTT may be a useful tool in suspected COVID-19 vaccine-related DHRs. Further evaluation with a larger patient cohort is required.
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Affiliation(s)
- Chris Weir
- Northern Blood Research Laboratory, Kolling Institute of Medical Research, Royal North Shore Hospital and the Sydney Medical School, University of Sydney, Sydney, Australia
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Helena Sung-In Jang
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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Jeffrey A, Coyle LA, Samaranayake D, Boyle T, Drummond J, Fernando SL. Central Nervous System (CNS) T-Cell Lymphoma as the Presenting Manifestation of Late-Onset Combined Immunodeficiency. Case Rep Hematol 2023; 2023:6650410. [PMID: 37886671 PMCID: PMC10599841 DOI: 10.1155/2023/6650410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023] Open
Abstract
Late-onset combined immunodeficiency (LOCID), considered now a subset of common variable immunodeficiency (CVID) disorders, is characterized by a predominantly T-cell immune defect. LOCID has a distinct phenotype from CVID with a greater risk of lymphoproliferative complications. As compared to the CVID cohort, LOCID patients also have increased rates of splenomegaly and granulomatous disease. We report a case of central nervous system (CNS) T-cell lymphoma in a 67-year-old male as the presenting manifestation of LOCID. The patient achieved a complete response to therapy after 4 cycles of MATRix (methotrexate, cytarabine, and thiotepa) and 2 cycles of ICE (etoposide, carboplatin, and ifosfamide) chemotherapy followed by CNS-directed autologous stem cell transplantation. Intravenous immunoglobulin replacement was commenced to address the underlying immunodeficiency. Pulmonary lesions consistent with a diagnosis of granulomatous and lymphocytic interstitial lung disease (GLILD) were identified as a second noninfectious complication of LOCID. The pulmonary lesions resolved after chemotherapy and immunoglobulin replacement. The patient remains well with no evidence of disease recurrence now more than 18 months after completion of therapy. This is the first reported case of T-cell lymphoma in an adult patient with LOCID. Further study is needed to elucidate the mechanisms of transformation of B- or T-cells to lymphoproliferation in primary immunodeficiency patients as well as research to inform evidence-based therapeutic strategies for this challenging cohort of patients.
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Affiliation(s)
- Anthony Jeffrey
- Department of Haematology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Luke A. Coyle
- Department of Haematology, Royal North Shore Hospital, St Leonards, NSW, Australia
- Department of Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Dishan Samaranayake
- Department of Haematology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Therese Boyle
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia
- Immunology Laboratory, Royal North Shore Hospital, New South Wales Health Pathology, St Leonards, NSW, Australia
| | - James Drummond
- Department of Radiology, Royal North Shore Hospital, Sydney, Australia
| | - Suran L. Fernando
- Department of Medicine, The University of Sydney, Sydney, NSW, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia
- Immunology Laboratory, Royal North Shore Hospital, New South Wales Health Pathology, St Leonards, NSW, Australia
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Boyle T, Zaragoza R, Li J, Cvetanovski V, Weaver P, Hoyle P, Venkatesha V, Fernando SL. A retrospective review of immunology patients with primary and/or secondary immunodeficiency, demonstrating the benefits of the rapid transitioning from intravenous immunoglobulin to subcutaneous immunoglobulin at the onset of the COVID-19 pandemic. Intern Med J 2023; 53:1256-1260. [PMID: 37092797 DOI: 10.1111/imj.16104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/08/2023] [Indexed: 04/25/2023]
Abstract
Forty-four of 50 immunology patients with primary or secondary immunodeficiency receiving intravenous immunoglobulin at a hospital in New South Wales, Australia, were rapidly enrolled in the subcutaneous immunoglobulin (SCIg) programme at the onset of the 2020 COVID-19 pandemic. Health and economic outcomes demonstrated that SCIg provides clinical efficacy as evidenced by the number of infections and maintenance of IgG levels, and also facilitates cost reduction in immunoglobulin maintenance programmes.
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Affiliation(s)
- Therese Boyle
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Reina Zaragoza
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jamma Li
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Vera Cvetanovski
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Phillippa Weaver
- Patient Safety and Quality Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Philip Hoyle
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Medical Services, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | | | - Suran L Fernando
- Clinical Immunology Department, Level 3, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Immunology Laboratory, Level 5, ASB, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Boyle T, O'Lone E, Phua E, Anderson J, Mather A, Fernando SL. Subsequent COVID-19 Prophylaxis in COVID-19 Associated Glomerulopathies. Vaccines (Basel) 2023; 11:1152. [PMID: 37514968 PMCID: PMC10385225 DOI: 10.3390/vaccines11071152] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 05/12/2023] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
Successful vaccination has been the decisive factor in the overall decline of SARS-CoV2 infection related morbidity and mortality. However, global effects of the COVID-19 pandemic are ongoing, with reports of glomerular disease occurring in relation to both infection and vaccination. A particular rise in anti-GBM disease has been identified. Information is still emerging regarding the optimal management of such cases. We reviewed anti-GBM antibody detection rates at our test center over the past 5 years. We followed three patients with biopsy confirmed glomerular disease temporally related to COVID-19 vaccination. Each patient proceeded to receive subsequent COVID-19 vaccination as per immunologist recommendations. Further assessment included COVID-19 antibody testing in each case. A three-fold increase in significant anti-GBM antibody results noted at our center was associated with COVID infection in 10% of cases, and COVID vaccination in 25% of cases. We demonstrated that subsequent vaccination did not appear to lead to adverse effects including relapse in our three cases of COVID-19 vaccine-associated GN. We also identified positive COVID-19 antibody levels in two out of three cases, despite immunosuppression. We report a rise in anti-GBM antibody disease incidence. Our small study suggests that COVID-19 antibody testing can help determine COVID prophylaxis requirements, and subsequent vaccination with an alternative vaccine type appears safe.
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Affiliation(s)
- Therese Boyle
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
| | - Emma O'Lone
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Elaine Phua
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Janet Anderson
- Immunology Laboratory, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Amanda Mather
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Department of Renal Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, Sydney, NSW 2050, Australia
- Immunology Laboratory, Royal North Shore Hospital, St Leonards, Sydney, NSW 2065, Australia
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Jacob JG, Fernando SL, Nickolls C, Li J. Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. J Paediatr Child Health 2023. [PMID: 37013273 DOI: 10.1111/jpc.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/26/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
AIM Oral food challenges (OFC) are an important tool in the assessment of food allergy. We sought to identify factors available at initial assessment visit which were associated with successful outcome or challenge failure in Australian children. METHODS We conducted a retrospective review of all paediatric patients who underwent OFC in our allergy service over a 5-year period. Clinical data comprising patient demographics, co-morbidities, skin prick test (SPT) results, nature of previous reactions, elapsed time since previous reactions and outcome at OFC were recorded. RESULTS Four hundred and fifty-six OFCs were conducted, with 56 cases (12.3%) resulting in a reaction. Likelihood of reaction at OFC was significantly increased for patients with atopic dermatitis (odds ratio 1.99). When stratified by food substance, atopic dermatitis had the strongest association with reaction within the peanut group (odds ratio 3.2), and no association was demonstrated for soy or prawn. Increasing SPT wheal size (P < 0.001) and previous history of anaphylaxis to the challenge food (P < 0.001) correlated with failure at OFC. A low-risk group was identified, of patients with no clear history of prior reaction to the challenge food, and SPT result <3 mm. CONCLUSIONS Factors identified at assessment visit which correlated with reaction at OFC are atopic dermatitis, prior history of anaphylaxis, and increasing SPT wheal size. Domiciliary OFC could be considered in a select low-risk group of patients undergoing food challenge. This study was performed at a single centre with limited sample size, further large-scale and multicentre study verification of our data will provide more accurate representation of the Australian demographic.
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Affiliation(s)
- Joshua G Jacob
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Nickolls
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Boyle T, Fernando SL, Drummond J, Fontes A, Parratt J. Phenotyping variants of tumefactive demyelinating lesions according to clinical and radiological features-A case series. Front Neurol 2023; 14:1092373. [PMID: 36816572 PMCID: PMC9935935 DOI: 10.3389/fneur.2023.1092373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Background Tumefactive demyelinating lesions (TDLs) are defined as lesions >2 cm on MRI of the brain. They are identified in a range of demyelinating diseases including massive demyelination due to Marburg's acute MS, Schilder's Disease, Balo's concentric sclerosis, and Tumefactive MS. Apart from the rare demyelinating variants which are often diagnosed histologically, there are no detailed data to phenotype TDLs. Methods We describe the clinical and radiological features of four similar patients with very large TDLs (>4 cm), that are not consistent with the rare demyelinating variants and may represent a distinct phenotype. Results All patients presented with hemiplegia and apraxia. The mean age at onset was 37 years with an equal sex distribution. All patients were diagnosed with Tumefactive demyelination based on MRI and CSF analysis, precluding the need for brain biopsy. All responded to potent immunotherapy (including high dose corticosteroids, plasma exchange, rituximab, and/or cyclophosphamide). The mean lag from diagnosis to treatment was 1 day. The median EDSS at presentation was six and recovery to a median EDSS of two occurred over 6 months. Conclusion We propose that Tumefactive lesions larger than 4 cm are termed "Giant demyelinating lesions" (GDLs) not only on the basis of size, but a rapid and fulminant demyelinating presentation leading to acute, severe neurological disability that is, nonetheless, responsive to immunotherapy. Further clinical studies are required to ratify this proposed phenotype, establish the immunological profile and best treatment for such patients.
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Affiliation(s)
- Thérèse Boyle
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,*Correspondence: Thérèse Boyle ✉
| | - Suran L. Fernando
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - James Drummond
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neuroradiology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ariadna Fontes
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Parratt
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Chatterton S, Xi S, Jia JX, Krause M, Long GV, Atkinson V, Menzies AM, Fernando SL, Boyle T, Kwok S, Duggins A, Karikios D, Parratt JDE. Case series: Immune checkpoint inhibitor-induced transverse myelitis. Front Neurol 2023; 14:1130313. [PMID: 36895912 PMCID: PMC9989185 DOI: 10.3389/fneur.2023.1130313] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Increasing implementation of the highly efficacious immune checkpoint inhibitors (ICIs) has raised awareness of their various complications in the form of immune-related adverse events (irAEs). Transverse myelitis following ICIs is thought to be a rare but serious neurologic irAE and knowledge is limited about this distinct clinical entity. Cases We describe four patients across three tertiary centers in Australia with ICI-induced transverse myelitis. Three patients had a diagnosis of stage III-IV melanoma treated with nivolumab and one patient had stage IV non-small cell lung cancer treated with pembrolizumab. All patients had longitudinally extensive transverse myelitis on magnetic resonance imaging (MRI) spine and clinical presentation was accompanied by inflammatory cerebrospinal fluid (CSF) findings. Half of our cohort had received spinal radiotherapy, with the areas of transverse myelitis extending beyond the level of previous radiation field. Inflammatory changes on neuroimaging did not extend to the brain parenchyma or caudal nerve roots, except for one case involving the conus medullaris. All patients received high dose glucocorticoids as first-line therapy, however the majority relapsed or had a refractory state (3/4) despite this, requiring escalation of their immunomodulation, with either induction intravenous immunoglobulin (IVIg) or plasmapheresis. Patients in our cohort who relapsed had a poorer outcome with more severe disability and reduced functional independence following resolution of their myelitis. Two patients had no progression of their malignancy and two patients had malignancy progression. Of the three patients who survived, two had resolution of their neurological symptoms and one remained symptomatic. Conclusion We propose that prompt intensive immunomodulation is favored for patients with ICI-transverse myelitis in an attempt to reduce associated significant morbidity and mortality. Furthermore, there is a significant risk of relapse following cessation of immunomodulatory therapy. We suggest one treatment approach of IVMP and induction IVIg for all patients presenting with ICI-induced transverse myelitis based on such findings. With the increasing use of ICIs across oncology, further studies are required to explore this neurological phenomenon in greater detail to help establish management consensus guidelines.
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Affiliation(s)
- Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Shuo Xi
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jessica Xi Jia
- Department of Neurology, Nepean Hospital, Sydney, NSW, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Oncology, Melanoma Institute Australia, Wollstonecraft, NSW, Australia.,Department of Medical Oncology, Mater Hospital, Wollstonecraft, NSW, Australia
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Alexander M Menzies
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Oncology, Melanoma Institute Australia, Wollstonecraft, NSW, Australia.,Department of Medical Oncology, Mater Hospital, Wollstonecraft, NSW, Australia
| | - Suran L Fernando
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Clinical Immunology and Allergy Department, Royal North Shore Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Thérèse Boyle
- Clinical Immunology and Allergy Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Samuel Kwok
- Department of Neurology, Nepean Hospital, Sydney, NSW, Australia
| | - Andrew Duggins
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Deme Karikios
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Nepean Hospital, Sydney, NSW, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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Pinto T, Li J, Boyle T, Zaragoza R, Fernando SL. Follow-up of penicillin allergy labels 1 year after successful penicillin delabeling. Ann Allergy Asthma Immunol 2023; 130:80-83.e3. [PMID: 36116749 DOI: 10.1016/j.anai.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Penicillin allergy delabeling confers many benefits, including reduced patient morbidity and mortality and improved health economics. Reports suggest that both patients and clinicians often remain hesitant to take and prescribe penicillins, respectively, after penicillin delabeling. However, follow-up of an individual's penicillin allergy label and incorporation of this into relevant health care records after delabeling have not been well studied in the Australian population. OBJECTIVE To evaluate the status of penicillin allergy labels in the community 1 year after penicillin delabeling at a tertiary hospital in Australia. METHODS A cross-sectional study was performed using follow-up interviews with patients and community primary care providers after 1 year from the date of patients' penicillin delabeling at a tertiary hospital in New South Wales, Australia. The main outcome measures that were evaluated included patient willingness to accept penicillin for future infections, patient self-reported receipt of penicillin-based antibiotics after delabeling, accuracy of penicillin allergy labels in the records of the primary care provider, and prescription of penicillin-based antibiotics by the general practitioner. RESULTS A total of 86 patients were included in this study. The percentage of patients with a correct penicillin allergy status at 1-year follow-up was 94% in the hospital electronic medical record but only 37% in primary care records. At 1-year follow-up, 14% of delabeled patients continued to reject penicillin prescriptions. CONCLUSION Better strategies are required to increase patient confidence in receiving penicillins after penicillin delabeling and to ensure that penicillin allergy labels are translated into the medical records at the primary care level.
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Affiliation(s)
- Trisha Pinto
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
| | - Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Sydney Medical School-Northern, The University of Sydney, Sydney, Australia; Immunology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, Australia
| | - Therese Boyle
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Sydney Medical School-Northern, The University of Sydney, Sydney, Australia; Immunology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, Australia.
| | - Reina Zaragoza
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Sydney Medical School-Northern, The University of Sydney, Sydney, Australia; Immunology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, Australia
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Weir C, Li J, Fulton R, Fernando SL. Development and initial validation of a modified lymphocyte transformation test (LTT) assay in patients with DRESS and AGEP. Allergy Asthma Clin Immunol 2022; 18:90. [PMID: 36210462 PMCID: PMC9548132 DOI: 10.1186/s13223-022-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
Abstract
Background The lymphocyte transformation test (LTT) is an in vitro assay used to diagnose drug induced hypersensitivity reactions by detecting the activation and expansion of drug-specific memory T cells to the suspected implicated drug. Traditionally radiolabelled thymidine (3H-thymidine) has been used but requires the handling and disposal of radioactive materials. Objective To examine safe alternatives to 3H-thymidine, test assay modifications for improved assay sensitivity and evaluate the modified LTT in patients with DRESS and AGEP. Methods Four proliferation detection assays (BRDU, CyQUANT™, MTT and XTT) were screened for LTT sensitivity. XTT the most sensitive and practical was selected for further evaluation Modifications like autologous serum (AS) and regulatory T cell depletion (T-REG) were tested for improved assay sensitivity. Finally, an initial evaluation of the XTT–LTT was performed in 8 patients with DRESS and 2 with AGEP including cytokine testing. Results Of the non-radioactive alternatives we tested, XTT a colorimetric assay was the most sensitive and practical to move to evaluation. The addition of AS increased background signal. Depletion of T-REGs improved sensitivity but cell sorting time and risk of contamination limited benefit. Of eight patients diagnosed with DRESS and 2 with AGEP tested with XTT–LTT assay results showed our assay matched clinical findings of implicated drugs in 8/10 patients when using a stimulation index (SI) ≥ 2 and 8/10 with analysis by ANOVA. All ten patients were correctly diagnosed by either analysis. Conclusion XTT appears to be a safe, viable alternative to 3H-thymidine, with high sensitivity and allowing direct cytokine quantification on specific patient cells.
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Li J, Sutton K, Ong L, Flower O, Gatward JJ, Jang H, Wood N, Hudson B, Tehrani S, Fernando SL. Recent SARS-CoV-2 infection: too early to vaccinate? Med J Aust 2022; 216:449-451. [PMID: 35462417 PMCID: PMC9115052 DOI: 10.5694/mja2.51499] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Jamma Li
- Royal North Shore HospitalSydneyNSW
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12
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Boyle T, Parratt J, Ong S, Fernando SL. Autoimmune encephalitis with anti-GluN1 and GluN2 receptor antibodies detected by ELISA. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.258] [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: 10/19/2022]
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13
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Sutton K, Weir C, Lewis N, Meulman A, Toon C, Boyle T, Fernando SL. Linear immunoglobulin A bullous dermatosis with severe ocular and oropharyngeal involvement. Pathology 2022. [DOI: 10.1016/j.pathol.2021.12.268] [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: 11/16/2022]
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14
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Fong AT, Jacob JG, Carroll B, Fernando SL. Acute dystonic reaction mimicking angioedema secondary to metoclopramide ingestion. Emerg Med Australas 2021; 33:762-763. [PMID: 33873238 DOI: 10.1111/1742-6723.13781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew T Fong
- Allergy and Immunology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,The Sydney Children's Hospital Network Westmead, Sydney, New South Wales, Australia
| | - Joshua G Jacob
- Allergy and Immunology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Bronwyn Carroll
- The Sydney Children's Hospital Network Randwick, Sydney, New South Wales, Australia.,Paediatric Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Suran L Fernando
- Allergy and Immunology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
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15
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Jacob JG, Parratt JDE, Kiely CJ, Fernando SL. Common variable immunodeficiency in association with autoimmune encephalitis, collagenous gastritis, and colitis. Ann Allergy Asthma Immunol 2021; 127:137-138. [PMID: 33812019 DOI: 10.1016/j.anai.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joshua G Jacob
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Immunology Laboratory, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - John D E Parratt
- University of Sydney, Sydney, Australia; Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | | | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Immunology Laboratory, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
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16
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Boyle T, Fernando SL, Steinfort B, Li J, Krause M, Harrington T, Assaad N, Faulder K. Medical treatment of polymeric cerebral granulomatous reactions following endovascular procedures. J Neurointerv Surg 2021; 13:1032-1036. [PMID: 33722971 DOI: 10.1136/neurintsurg-2020-016806] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Endovascular procedures are standard of care for an increasing range of cerebrovascular diseases. Many endovascular devices contain plastic and are coated with a hydrophilic polymer which has been rarely described to embolize, resulting in distal granulomatous inflammatory lesions within the vascular territory. METHODS We reviewed three cases of cerebral granulomatous reactions that occurred after endovascular intervention for internal carotid aneurysms. The patient procedure details, presentation, relevant investigations, and treatment course are described. We also provide a literature review on endovascular granulomatous reactions. RESULTS These three cases represent the largest biopsy proven series of cerebral granulomatosis following endovascular intervention. We highlight the variable clinical presentation, with two of the three cases having an unusually delayed onset of up to 4 years following the intervention. We show the characteristic histological findings of granulomatous lesions with foreign body material consistent with a type IV reaction, radiological abnormalities of enhancing lesions within the vascular territory of the intervention, and the requirement of prolonged immunosuppression for maintenance of clinical remission, with two of the three patients requiring a corticosteroid sparing agent. In comparison with the available literature, in addition to hydrophilic gel polymer, we discuss that plastic from the lining of the envoy catheter may be a source of embolic material. We also discuss the recommendations of the Food and Drug Administration and the implementation of novel biomaterials for the prevention of these reactions in the future. CONCLUSIONS There is a need for increased awareness of this severe complication of cerebral endovascular procedures and further longitudinal studies of its prevalence, optimal management and preventative measures.
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Affiliation(s)
- Therese Boyle
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Medicine (Immunology and Infectious Diseases), The University of Sydney, Sydney, New South Wales, Australia
| | - Brendan Steinfort
- Neurosurgery Department-Interventional Neuroradiology Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,Medicine (Immunology and Infectious Diseases), The University of Sydney, Sydney, New South Wales, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Tim Harrington
- Neurosurgery Department-Interventional Neuroradiology Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Nazih Assaad
- Neurosurgical Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Ken Faulder
- Neurosurgery Department-Interventional Neuroradiology Unit, Royal North Shore Hospital, St Leonards, New South Wales, Australia
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17
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Fernando SL, Capon MJ, Green SL, Boyle MJ. Pharmacovigilance for chlorhexidine anaphylaxis: a preventable adverse reaction. Med J Aust 2021; 214:162-163.e1. [PMID: 33527357 DOI: 10.5694/mja2.50929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Suran L Fernando
- Royal North Shore Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | | | - Michael J Boyle
- John Hunter Hospital, Newcastle, NSW.,University of Newcastle, Newcastle, NSW
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18
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Fernando SL, Jang HSI, Li J. The Immune Dysregulation of Common Variable Immunodeficiency Disorders. Immunol Lett 2021; 230:21-26. [DOI: 10.1016/j.imlet.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/19/2022]
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19
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van Nguyen D, Chu HC, Vidal C, Fulton RB, Nguyen NN, Quynh Do NT, Tran TL, Nguyen TN, Thu Nguyen HT, Chu HH, Thanh Thuc HT, Minh Le HT, van Nunen S, Anderson J, Fernando SL. Genetic susceptibilities and prediction modeling of carbamazepine and allopurinol-induced severe cutaneous adverse reactions in Vietnamese. Pharmacogenomics 2020; 22:1-12. [PMID: 33356553 DOI: 10.2217/pgs-2019-0146] [Citation(s) in RCA: 8] [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] [Indexed: 12/18/2022] Open
Abstract
Aims: To determine genetic susceptibility markers for carbamazepine (CBZ) and allopurinol-induced severe cutaneous adverse reactions (SCARs) in Vietnamese. Methods: A case-control study was performed involving 122 patients with CBZ or allopurinol-induced SCARs and 120 drug tolerant controls. Results: HLA-B*58:01 was strongly associated with allopurinol-induced SCARs and strongly correlated with SNP rs9263726. HLA-B*15:02 was associated with CBZ-induced Stevens-Johnson syndrome/toxic epidermal necrolysis but not with drug-induced hypersensitivity syndrome/drug rash with eosinophilia and systemic symptoms. No association was found between HLA-A*31:01 and CBZ-induced SCARs. HLA-B*58:01 and rs3909184 allele A with renal insufficiency were shown to increase the risk of allopurinol-induced SCARs. Conclusion: HLA-B*58:01 and HLA-B*15:02 confer susceptibility to allopurinol-induced SCARs and CBZ-induced SJS/TEN in Vietnamese. SNP rs9263726 can be used as a surrogate marker in identifying HLA-B*58:01.
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Affiliation(s)
- Dinh van Nguyen
- Vinmec Healthcare System, Hanoi, 100000, Vietnam.,College of Health Science, VinUniversity, Hanoi, 100000, Vietnam.,Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Hieu Chi Chu
- Center of Allergology & Clinical Immunology, Bach Mai Hospital, Hanoi, 115000, Vietnam
| | - Christopher Vidal
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia
| | - Richard B Fulton
- ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Nguyet Nhu Nguyen
- Center of Allergology & Clinical Immunology, Bach Mai Hospital, Hanoi, 115000, Vietnam
| | - Nga Thi Quynh Do
- Department of Immunology & Molecular Biology, National Institute of Hygiene & Epidemiology, Hanoi, 100000, Vietnam
| | | | | | - Ha Thi Thu Nguyen
- Department of Allergy & Clinical Immunology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Hanh Hong Chu
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Thuc
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Huong Thi Minh Le
- Department of Allergy, Immunology & Rheumatology, National Hospital of Pediatrics, Hanoi, 100000, Vietnam
| | - Sheryl van Nunen
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,Department of Clinical immunology & Allergy, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Janet Anderson
- ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia
| | - Suran L Fernando
- Sydney Medical School - Northern, The University of Sydney, Sydney, 2065, Australia.,ImmunoRheumatology Laboratory, NSW Health Pathology-North, Royal North Shore Hospital, Sydney, 2065, Australia.,Department of Clinical immunology & Allergy, Royal North Shore Hospital, Sydney, 2065, Australia
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20
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Mueller‐Wirth N, Buenter A, Jörg L, Ebo DG, Glatz M, Fernando SL, Spoerl D, Helbling A, Hausmann O, Gupta N, Pichler WJ. IgE-mediated chlorhexidine allergy-Cross-reactivity with other biguanide disinfectants. Allergy 2020; 75:3237-3247. [PMID: 32678912 DOI: 10.1111/all.14497] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chlorhexidine (CHX) is a widely utilized disinfectant that can cause IgE-mediated urticaria/anaphylaxis. The cross-reactivity of patients with IgE-mediated CHX allergy with other disinfectants, which share structural similarities with CHX like polyhexanide (polyhexamethylene biguanide; PHMB), alexidine (ALX), or octenidine (OCT), is unknown. METHODS Forty-four patients with anaphylaxis or urticaria upon CHX exposure and positive skin prick test (SPT) and/or positive CHX ImmunoCAP test (Phadia TFS, Uppsala, Sweden) were recruited. IgE to the biguanide and/or hexamethylene structure was investigated with PHMB ImmunoCAP (n = 32) and by basophil activation tests (BAT) with CHX and ALX (n = 37). Inhibition tests of CHX and PHMB ImmunoCAPs by CHX, ALX, PHMB, and OCT were performed. RESULTS IgE reactivity to PHMB as surrogate marker for biguanide/hexamethylene reactivity was detected in 5/32 sera. Seven of 37 patients showed a positive BAT with ALX, but only under optimized conditions. Binding to CHX ImmunoCAP was inhibited by ALX in 1/32 sera, and binding to PHMB was blocked by ALX (1/5) and by OCT in another (1/5). In SPT, 9/10 patients were positive for CHX and 3 of them with ALX (only at highest concentration at 5 mg/mL). A further patient reacted primarily with OCT and showed IgE cross-reactivity with CHX, ALX, and PHMB. CONCLUSION The IgE response to CHX seems polyclonal. The chloroguanide ending of CHX is the main epitope for the IgE and is suitable as screening assay to detect CHX reactivity. IgE-reactivities with the biguanide or hexamethylene components of other disinfectants (ALX, PHMB) can be detected by SPT, PHMB ImmunoCAP, and ALX-BAT in 15%-33% of CHX-allergic patients.
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Affiliation(s)
| | - Antonia Buenter
- ADR‐AC GmbH Bern Switzerland
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
| | - Lukas Jörg
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
| | - Didier G. Ebo
- Department of Immunology ‐ Allergology – Rheumatology and the Infla‐Med Centre of Excellence University AntwerpAntwerp University Hospital Antwerpen Belgium
| | - Martin Glatz
- Allergiestation University of Zurich Zurich Switzerland
| | - Suran L. Fernando
- Faculty of Medicine and Health (Immunology and Infectious Diseases) University of Sydney Sydney NSW Australia
| | - David Spoerl
- Department of Clinical Immunology and Allergy HUG Geneva Geneva Switzerland
| | - Arthur Helbling
- Dep. of Rheumatology, Immunology and Allergology, Inselspital University of Bern Bern Switzerland
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21
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Anderson J, Green S, Capon M, Krupowicz B, Li J, Fulton R, Fernando SL. Measurement of pholcodine-specific IgE in addition to morphine-specific IgE improves investigation of neuromuscular blocking agent anaphylaxis. Br J Anaesth 2020; 125:e450-e452. [DOI: 10.1016/j.bja.2020.05.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
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22
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Sutton KM, Fernando SL. A 6-step rapid desensitization protocol to hydroxychloroquine. Ann Allergy Asthma Immunol 2020; 126:292-293. [PMID: 33276119 DOI: 10.1016/j.anai.2020.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/26/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Kathryn M Sutton
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia; Department of Immunology and Infectious Diseases, Northern Clinical School, University of Sydney, Sydney, Australia.
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23
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Fernando SL. Sifting through the history of the nosology of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis and its clinicopathological relevance. Int J Dermatol 2020; 60:110-112. [PMID: 33252777 DOI: 10.1111/ijd.15284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/20/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore, Sydney, NSW, Australia.,Immunology Laboratory, New South Wales Health Pathology, Royal North Shore, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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24
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Hultin S, Nahar K, Menzies AM, Long GV, Fernando SL, Atkinson V, Cebon J, Wong MG. Histological diagnosis of immune checkpoint inhibitor induced acute renal injury in patients with metastatic melanoma: a retrospective case series report. BMC Nephrol 2020; 21:391. [PMID: 32894101 PMCID: PMC7487459 DOI: 10.1186/s12882-020-02044-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/23/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Immune checkpoint inhibitors (ICI) have become the standard of care in many oncological conditions but are associated with a spectrum of renal immune-related adverse events (IrAEs). We aimed to describe the spectrum, histology, management and outcomes of renal IrAE in patients with metastatic melanoma undergoing ICI therapy. METHODS We conducted a retrospective review of 23 patients with a diagnosis of metastatic melanoma treated with ICI between January 2017 and April 2019 who developed a renal IrAE. Baseline demographic data, biochemical and histopathological results, management and outcomes were analyzed. RESULTS The majority of patients who developed renal irAE were male and received combination immunotherapy. The median time of onset from initiation of ICI therapy to renal IrAE was 4 months. 52% of the treated renal IrAE had histopathologically confirmed renal IrAE. The most common histological pattern of injury was acute tubulo-interstitial nephritis (92%). One patient developed anti-GBM disease with non-dialysis dependent stage 5 CKD. In tubulointerstitial injury, there was no association between peak creatinine, renal recovery and histologically reported inflammation or fibrosis. Patients with renal IrAE demonstrated persisting renal dysfunction at 3, 6 and 12 months with a mean baseline, 3 and 12 month creatinine of 90.0 μmol/L, 127.0 μmol/L and 107.5 μmol/L respectively. CONCLUSION Renal IrAE is most commonly attributable to steroid responsive acute tubulointerstitial nephritis. The outcome of rarer pathologies such as anti-GBM disease may be adversely affected by a delayed diagnosis. There is persisting renal dysfunction following an episode of renal IrAE that may have impact on future renal and overall survival outcomes.
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Affiliation(s)
- Sebastian Hultin
- Department of Renal Medicine Royal North Shore Hospital, Sydney, Australia. .,Sydney Medical School, The University of Sydney, Sydney, Australia. .,Westmead Institute of Medical Research, 176 Hawkesbury Road, Westmead, NSW2145, Australia.
| | - Kazi Nahar
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospital, Sydney, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, Australia.,Department of Medical Oncology, Royal North Shore Hospital and Mater Hospital, Sydney, Australia
| | - Suran L Fernando
- Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Immunopathology, NSW Health Pathology North, Sydney, Australia
| | - Victoria Atkinson
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Jonathan Cebon
- Olivia Newton-John Cancer Research Institute at Austin Health, Heidelberg, Australia
| | - Muh Geot Wong
- Department of Renal Medicine Royal North Shore Hospital, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
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25
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Fernando SL, Boyle T. Presence of dual anti-MPO and anti-PR3 antibodies in Systemic Lupus Erythematosus/ANCA-Associated Vasculitis. J Clin Pathol 2020; 73:687-688. [PMID: 32513843 DOI: 10.1136/jclinpath-2019-206244] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/29/2020] [Accepted: 05/19/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Suran L Fernando
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Therese Boyle
- Immunology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia .,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia
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26
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Jang HS, Flinsenberg TWH, Lacaze P, Thia KYT, Noori T, Fernando SL, Kerridge I, Riaz M, McNeil JJ, Blombery PA, Trapani JA, Voskoboinik I. Recovery of natural killer cell cytotoxicity in a p.A91V perforin homozygous patient following severe haemophagocytic lymphohistiocytosis. Br J Haematol 2020; 190:458-461. [PMID: 32342501 DOI: 10.1111/bjh.16660] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 03/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Helena S Jang
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Thijs W H Flinsenberg
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Kevin Y T Thia
- Cancer Immunology Program, Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tahereh Noori
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Ian Kerridge
- Department of Haematology, Royal North Shore Hospital, Sydney, Australia
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Piers A Blombery
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Joseph A Trapani
- Cancer Immunology Program, Cancer Cell Death Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Ilia Voskoboinik
- Cancer Immunology Program, Killer Cell Biology Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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27
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Boyle T, Jang HS, Fulton RB, King G, Fernando SL. The fluorescence enzyme immunoassay has greater utility than the gel precipitin test for the detection of specific IgG antibodies to Aspergillus fumigatus in the diagnosis of allergic bronchopulmonary aspergillosis. Pathology 2020; 52:497-499. [PMID: 32317173 DOI: 10.1016/j.pathol.2020.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/07/2020] [Accepted: 02/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Therese Boyle
- Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia.
| | - Helena S Jang
- Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Richard B Fulton
- Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Gregory King
- Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Suran L Fernando
- Immunorheumatology Laboratory, NSW Health Pathology, Royal North Shore Hospital, St Leonards, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia; Sydney Medical School-Northern, Sydney University, Sydney, NSW, Australia
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28
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Fernando SL, Li J, Jain A, Weir C, Boyle T. Mixed drug reaction to amiodarone characterized by sequential immediate, immune complex, and delayed hypersensitivity. Ann Allergy Asthma Immunol 2020; 125:102-103. [PMID: 32283252 DOI: 10.1016/j.anai.2020.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - Jamma Li
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - Arunima Jain
- Department of Cardiology, Gosford Hospital, Gosford, Australia
| | - Christopher Weir
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Therese Boyle
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, Australia
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Jang HS, Proos A, Koe L, Anderson J, Fulton R, Fernando SL. HIgh accuracy of HLA-B*27 genotyping by allele-specific real-time polymerase chain reaction in a heterogeneous population. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.162] [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: 11/26/2022]
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Jang HS, Proos A, Koe L, Anderson J, Fulton R, Fernando SL. High accuracy of HLA-B*27 genotyping by allele-specific real-time polymerase chain reaction in a heterogeneous population compared to flow cytometry and single nucleotide polymorphism detection assays. Pathology 2020; 52:256-261. [PMID: 31902620 DOI: 10.1016/j.pathol.2019.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 08/29/2019] [Accepted: 09/15/2019] [Indexed: 12/17/2022]
Abstract
HLA-B27 is a risk marker for ankylosing spondylitis and other associated seronegative spondyloarthropathies. We compared three methods of HLA-B*27 typing in a New South Wales (NSW) population: flow cytometry, rs4349859 single nucleotide polymorphism (SNP) detection assay, and allele-specific real-time polymerase chain reaction (RT-PCR) analysis of exons 2 and 3. Over a 5-month period, 543 samples underwent flow cytometric testing and RT-PCR high-resolution melt analysis of rs4349859 SNP and of exon 2 (5' fragment) and exon 3. In the third method, positive samples were further analysed with fluorescent resonance emission transfer (FRET) RT-PCR of exon 2 fragments, 2a and 2b. HLA-B*27 and other genotypes were confirmed by Sanger sequencing of a 600 base pair fragment of exons 2 and 3. In our cohort, the rs4349859 SNP method had 78.6% sensitivity and 98.7% specificity. Screening with exon 2 (5' fragment) and exon 3 RT-PCR provided 100% sensitivity. Further testing with exon 2a and 2b FRET RT-PCR produced 100% specificity. This cascade approach with allele-specific RT-PCR assays was able to differentiate all samples into HLA-B*27 subtypes. HLA-B*27 genotyping with allele-specific RT-PCR assays, to screen for and confirm HLA-B27 positive samples, was more sensitive and specific than flow cytometry and rs4349859 SNP assays. It is a potentially cost-effective method for differentiating HLA-B27 subtypes. Our cascade genetic testing approach is suitable for replacing the current flow cytometric HLA-B27 assay for the heterogeneous NSW population.
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Affiliation(s)
- Helena S Jang
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - Annè Proos
- Molecular Genetics Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lisa Koe
- Molecular Genetics Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Janet Anderson
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Richard Fulton
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Suran L Fernando
- Immunorheumatology Laboratory, New South Wales Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, NSW, Australia; The University of Sydney, Sydney, NSW, Australia
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Li J, Green SL, Krupowicz BA, Capon MJ, Lindberg A, Hoyle P, Fernando SL. Cross-reactivity to penicillins in cephalosporin anaphylaxis. Br J Anaesth 2019; 123:e532-e534. [DOI: 10.1016/j.bja.2019.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022] Open
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Affiliation(s)
| | | | - Muh G Wong
- Department of Renal Medicine, Royal North Shore Hospital.,Department of Medicine, The University of Sydney
| | - Hwei-Choo Soh
- Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy.,Department of Medicine, The University of Sydney
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Nguyen DV, Anderson J, Vidal C, Fulton R, Li J, Fernando SL. The utility of surrogate markers in predicting HLA alleles associated with adverse drug reactions in Vietnamese. Asian Pac J Allergy Immunol 2019; 40:134-140. [PMID: 31421661 DOI: 10.12932/ap-170219-0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Screening for HLA-A*31:01/HLA-B*15:02, HLA-B*57:01 and HLA-B*58:01 is recommended in selected populations for prevention of carbamazepine, abacavir, and allopurinol-induced severe cutaneous adverse reactions (SCARs). Compared to conventional methods for detection of HLA alleles, PCR using a tag single nucleotide polymorphism (SNP) can be cost-effective, particularly where the surrogate marker SNP is in absolute linkage disequilibrium with the relevant HLA allele. OBJECTIVE To determine guidelines for prevention of SCARs though predictive screening for the Australian Vietnamese population, the prevalence of four HLA alleles (HLA-A*31:01, HLA-B*15:02, HLA-B*57:01 and HLA-B*58:01) was examined. The utility of surrogate markers, rs2395029 and rs9263726, was investigated to predict for the presence of HLA-B*57:01 and HLA-B*58:01, respectively. METHODS Genotyping for specific HLA alleles was performed in 152 healthy Vietnamese living in Sydney using validated and established PCR-based methods. SNP genotyping was conducted using restriction-fragment-length-polymorphism analysis. RESULTS rs2395029 and rs9263726 strongly correlated with HLA-B*57:01 (? = 1, p < 0.001) and HLA-B*58:01 (Κ = 0.9, p < 0.001) with 100% sensitivity and 100% negative predictive value for predicting the HLA-B*57:01 and HLA-B*58:01 carriers, respectively. A high prevalence of carriers of HLA-A*31:01 (3.29%), HLA-B*15:02 (14.47%), HLA-B*57:01 (6.58%) and HLA-B*58:01 (9.21%) was revealed. CONCLUSIONS Screening is recommended for these alleles in Australian Vietnamese prior to introducing relevant therapies. SNPs, rs2395029 and rs9263726, can be successfully used as surrogate markers for HLA-B*57:01 and HLA-B*58:01 in this population.
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Affiliation(s)
- Dinh Van Nguyen
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School-Northern, The University of Sydney, Sydney, Australia.,Division of Allergy and Clinical Immunology, Vinmec International Hospital Times City, Hanoi, Vietnam
| | - Janet Anderson
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia
| | - Christopher Vidal
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia
| | - Richard Fulton
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia
| | - Jamma Li
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School-Northern, The University of Sydney, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- ImmunoRheumatology Laboratory, New South Wales Health Pathology-North, Royal North Shore Hospital, Sydney, Australia.,Sydney Medical School-Northern, The University of Sydney, Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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Li J, Shahabi-Sirjani A, Figtree M, Hoyle P, Fernando SL. Safety of direct drug provocation testing in adults with penicillin allergy and association with health and economic benefits. Ann Allergy Asthma Immunol 2019; 123:468-475. [PMID: 31419490 DOI: 10.1016/j.anai.2019.08.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Nonprescription of penicillin-containing antibiotics in patients diagnosed with penicillin allergy is associated with morbidity and mortality. Adverse reactions to penicillins comprise type A and B reactions. OBJECTIVE To assess the feasibility of penicillin allergy evaluation without penicillin skin testing (PST) for adult patients with type B reactions and the health and economic benefits of this process. METHODS Inpatients at an Australian tertiary hospital between April 1, 2017, and April 30, 2018, with a diagnosis of type B penicillin allergy, requiring a penicillin-containing antibiotic for treatment, were included. All patients underwent clinical history review, PST, and drug provocation testing (DPT). RESULTS Seventy-one patients were enrolled. Sixty-three reported a history of type B or unknown adverse reactions. No patients had a history of anaphylaxis requiring intubation or epinephrine within the last 10 years or a history suggesting Gell and Coombs type 2, 3, or 4 (severe) hypersensitivity reaction. Seven did not complete DPT because the treating team used a β-lactam antibiotic other than amoxicillin. Fifty-four of 56 remaining patients (96%) completed 3-day DPT to amoxicillin with no adverse reaction. Two experienced mild cutaneous reactions. Penicillin allergy evaluation was significantly associated with reduced length of stay, reduced hospital expenditure on bed and second-line antibiotics, and reduced readmission rates. CONCLUSION Penicillin allergy evaluation with DPT without PST may be feasible for all adult patients with a reported history of type B reactions to penicillins who do not have a history of anaphylaxis within the last 10 years or a type 2, 3, or 4 (severe) hypersensitivity reaction.
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Affiliation(s)
- Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia.
| | | | - Melanie Figtree
- New South Wales Health Pathology, Sydney, Australia; Department of Infectious Diseases, Royal North Shore Hospital, Sydney, Australia
| | - Philip Hoyle
- Executive Unit, Northern Sydney Local Health District, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; New South Wales Health Pathology, Sydney, Australia; University of Sydney, Sydney, Australia
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Affiliation(s)
- Lachlan M. McDowall
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, Australia
- Address reprint requests and correspondence: Dr Lachlan M. McDowall c/o Dr Karin Chia, Department of Cardiology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW, Australia, 2065.
| | - Suran L. Fernando
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
- ImmunoRheumatology Laboratory, New South Wales Health Pathology, Sydney, Australia
| | - Nikhita Ange
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - James Yun
- Faculty of Medicine, Northern Clinical School, University of Sydney, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Karin K.M. Chia
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia
- Department of Cardiology, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
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Affiliation(s)
- Brian Lam
- Royal North Shore Hospital, Sydney, NSW
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Li J, Best OG, Rose MA, Green SL, Fulton RB, Capon MJ, Krupowicz BA, Fernando SL. Assessing cross-reactivity to neuromuscular blocking agents by skin and basophil activation tests in patients with neuromuscular blocking agent anaphylaxis. Br J Anaesth 2019; 123:e144-e150. [PMID: 30961915 DOI: 10.1016/j.bja.2019.03.001] [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] [Received: 12/24/2018] [Revised: 02/20/2019] [Accepted: 03/01/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Following diagnosis of neuromuscular blocking agent (NMBA) anaphylaxis, identifying safe alternatives for subsequent anaesthesia is critical. A patient with anaphylaxis to one NMBA can also have an allergic reaction to other NMBAs (cross-reactivity). Whilst drug provocation testing is standard for identifying or excluding allergy, there is significant risk. In vitro, after an allergen activates basophils, basophils express surface activation markers that can be measured by basophil activation testing (BAT). We compared cross-reactivity between NMBAs assessed by BAT against that by skin testing. METHODS All patients attending an anaesthetic allergy clinic in Sydney, Australia between May 2017 and July 2018 diagnosed with NMBA anaphylaxis qualified for this study comparing intradermal skin tests and BAT with a panel of NMBAs (rocuronium, vecuronium, pancuronium, suxamethonium, cisatracurium). RESULTS Of the 61 patients participating, sensitisation on skin testing and on BAT completely matched in only nine patients (15%). Sensitisation was not in agreement for pancuronium, cisatracurium and rocuronium, but was in agreement for vecuronium and suxamethonium. Nine patients with negative skin tests subsequently tolerated cisatracurium, and one false positive on BAT to cisatracurium was detected. CONCLUSIONS The utility of BAT in identifying safe NMBAs for subsequent anaesthesia needs further evaluation. BAT detects a different cross-reactivity profile to skin tests. Negative skin testing and BAT might increase confidence in performing drug provocation testing, but this and follow-up of subsequent anaesthesia in our cohort is necessary to determine the clinical significance of BAT sensitisation.
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Affiliation(s)
- Jamma Li
- Department of Clinical Immunology and Allergy, Australia; Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia; NSW Health Pathology, Sydney, Australia.
| | - Oliver G Best
- Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia
| | - Michael A Rose
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia
| | - Sarah L Green
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia
| | | | - Marc J Capon
- Department of Anaesthesia, Royal North Shore Hospital, Sydney, Australia
| | | | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Australia; Medicine (Immunology & Infectious Diseases), University of Sydney, Sydney, Australia; NSW Health Pathology, Sydney, Australia
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Jang HS, Proos A, Koe L, Anderson J, Fulton R, Fernando SL. HLA-B*27 genotyping by real-time polymerase chain reaction is superior to rs4349859 single nucleotide polymorphism detection and flow cytometry in a heterogeneous population. Pathology 2019. [DOI: 10.1016/j.pathol.2018.12.342] [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: 11/26/2022]
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Aouad P, Yiannikas C, Fernando SL, Parratt J. A case of autoimmune myositis after treatment with alemtuzumab for multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217318819012. [PMID: 30622727 PMCID: PMC6302273 DOI: 10.1177/2055217318819012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 11/04/2018] [Accepted: 11/14/2018] [Indexed: 12/02/2022] Open
Abstract
Alemtuzumab is a high-efficacy disease-modifying therapy for the treatment of relapsing forms of multiple sclerosis and is associated with secondary autoimmune adverse events. We report a novel case of secondary autoimmune myositis that occurred seven months after the initial treatment cycle and achieved full recovery with oral corticosteroids. This particular form of myositis appears to be unique, and is likely to be a distinct entity from the other four types of immune-mediated myositis.
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Affiliation(s)
- Patrick Aouad
- Northern Clinical School, University of Sydney, AustraliaDepartment of Neurology, Royal North Shore Hospital, Australia
| | - Con Yiannikas
- Department of Neurology, Royal North Shore Hospital, Australia
| | - Suran L Fernando
- Northern Clinical School, University of Sydney, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Australia
| | - John Parratt
- Department of Neurology, Royal North Shore Hospital, AustraliaNorthern Clinical School, University of Sydney, Australia
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Li J, Fulton RB, O'Connell R, Jang HS, Fernando SL. Specific-IgE to galactose-α-1,3-galactose (alpha-gal) has limited utility in diagnosing meat allergy in a tick-endemic population. Ann Allergy Asthma Immunol 2018; 121:509-511. [PMID: 29966704 DOI: 10.1016/j.anai.2018.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jamma Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia.
| | - Richard B Fulton
- Immunorheumatology Laboratory, NSW Health Pathology, Sydney, Australia
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Jang HS, Cai F, Kaufman A, Broadfoot A, Fernando SL. A case of refractory linear IgA disease responsive to high-dose intravenous immunoglobulin therapy. Pathology 2018. [DOI: 10.1016/j.pathol.2017.12.314] [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: 10/17/2022]
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Ange N, Alley S, Fernando SL, Coyle L, Yun J. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome successfully treated with mepolizumab. J Allergy Clin Immunol Pract 2017; 6:1059-1060. [PMID: 29133221 DOI: 10.1016/j.jaip.2017.10.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Nikhita Ange
- Department of Clinical Allergy and Immunology, Royal North Shore Hospital, Sydney, Australia
| | - Sonia Alley
- Department of Clinical Allergy and Immunology, Royal North Shore Hospital, Sydney, Australia; Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Department of Clinical Allergy and Immunology, Royal North Shore Hospital, Sydney, Australia; ImmunoRheumatology Laboratory, Pathology North, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia
| | - Luke Coyle
- Department of Haematology and Transfusion Medicine, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia; Haematology, Pathology North, Royal North Shore Hospital, Sydney, Australia
| | - James Yun
- Department of Clinical Allergy and Immunology, Royal North Shore Hospital, Sydney, Australia; The University of Sydney, Sydney, Australia.
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Affiliation(s)
- N Ange
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
| | - McDowall LM
- Department of Cardiology, Royal North Shore Hospital; Sydney Australia
- University of New South Wales; Sydney Australia
| | - J Yun
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- The University of Sydney; Sydney Australia
| | - KKM Chia
- Department of Cardiology, Royal North Shore Hospital; Sydney Australia
- University of Queensland; Brisbane Australia
| | - SL Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- The University of Sydney; Sydney Australia
- ImmunoRheumatology Laboratory; New South Wales Australia
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Li J, Fulton RB, Yun J, Fernando SL. P44: SPECIFIC IGE TO GALACTOSE-ALPHA-1,3-GALACTOSE (ALPHA-GAL) DOES NOT ADD TO THE DIAGNOSIS OF MAMMALIAN MEAT ALLERGY IN A TICK-ENDEMIC POPULATION. Intern Med J 2017. [DOI: 10.1111/imj.44_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J Li
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- University of Sydney; Sydney Australia
| | - RB Fulton
- NSW Health Pathology-North; Sydney Australia
| | - J Yun
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- University of Sydney; Sydney Australia
| | - SL Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- University of Sydney; Sydney Australia
- NSW Health Pathology-North; Sydney Australia
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Anderson J, Green S, Rose M, Fernando SL. P7: THE ABSENCE OF POSITIVE MORPHINE SPECIFIC IgE IN A PROPORTION OF PATIENTS WITH HYPERSENSITIVITY TO ROCURONIUM. Intern Med J 2017. [DOI: 10.1111/imj.7_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - S Green
- Department of Anaesthesia, Royal North Shore Hospital; Sydney Australia
| | - M Rose
- Department of Anaesthesia, Royal North Shore Hospital; Sydney Australia
| | - SL Fernando
- Immunorheumatology; Sydney Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- University of Sydney; Sydney Australia
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Jang HS, Fulton RB, Kaufman A, Fernando SL. CGR 8: A NOVEL CASE FEATURING AN IgE PARAPROTEIN ASSOCIATED WITH FAMILIAL MEDITERRANEAN FEVER. Intern Med J 2017. [DOI: 10.1111/imj.8_13579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- HS Jang
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- Immunorheumatology Laboratory; NSW Health Pathology, Royal North Shore Hospital Sydney Australia
| | - RB Fulton
- Immunorheumatology Laboratory; NSW Health Pathology, Royal North Shore Hospital Sydney Australia
| | - A Kaufman
- Department of Anatomical Pathology; NSW Health Pathology, Royal North Shore Hospital Sydney Australia
| | - SL Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital; Sydney Australia
- Immunorheumatology Laboratory; NSW Health Pathology, Royal North Shore Hospital Sydney Australia
- Sydney Medical School; University of Sydney; Sydney Australia
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Van Nguyen D, Vidal C, Chi HC, NTQ D, Nguyen NN, HTT N, Nguyen NT, TTL T, Fulton R, Li J, Fernando SL. P72: GENE PROFILING STUDIES DEMONSTRATE THE ROLE OF INNATE IMMUNE RESPONSES IN ALLOPURINOL-INDUCED SEVERE CUTANEOUS ADVERSE REACTIONS. Intern Med J 2017. [DOI: 10.1111/imj.72_13578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D Van Nguyen
- Sydney Medical School-Northern; University of Sydney; Sydney Australia
- ImmunoRheumatology Laboratory; New South Wales Sydney Australia
- Department of Allergy and Clinical Immunology; Hanoi Medical University; Hanoi Vietnam
| | - C Vidal
- ImmunoRheumatology Laboratory; New South Wales Sydney Australia
| | - HC Chi
- Centre of Allergology and Clinical Immunology, Bach Mai Hospital; Hanoi Vietnam
| | - Do NTQ
- Department of Immunology and Molecular Biology, National Institute of Hygiene and Epidemiology; Hanoi Vietnam
| | - NN Nguyen
- Centre of Allergology and Clinical Immunology, Bach Mai Hospital; Hanoi Vietnam
| | - Nguyen HTT
- Department of Allergy and Clinical Immunology; Hanoi Medical University; Hanoi Vietnam
| | | | - Tran TTL
- Hanoi Heart Hospital; Hanoi Vietnam
| | - R Fulton
- ImmunoRheumatology Laboratory; New South Wales Sydney Australia
| | - J Li
- ImmunoRheumatology Laboratory; New South Wales Sydney Australia
| | - SL Fernando
- Sydney Medical School-Northern; University of Sydney; Sydney Australia
- ImmunoRheumatology Laboratory; New South Wales Sydney Australia
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Van Nguyen D, Chu HC, Vidal C, Nguyen NN, Quynh Do NT, Linh Tran TT, Chu HH, Thu Nguyen HT, Thuc HT, Minh Le HT, Fulton RB, Fernando SL. Genetic Susceptibility to Carbamazepine and Allopurinol–Induced Severe Cutaneous Adverse Reactions in Vietnamese. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.378] [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: 10/20/2022]
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Nguyen DV, Vida C, Chu HC, Fulton R, Li J, Fernando SL. Validation of a Rapid, Robust, Inexpensive Screening Method for Detecting the HLA-B*58:01 Allele in the Prevention of Allopurinol-Induced Severe Cutaneous Adverse Reactions. Allergy Asthma Immunol Res 2017; 9:79-84. [PMID: 27826965 PMCID: PMC5102839 DOI: 10.4168/aair.2017.9.1.79] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 06/28/2016] [Indexed: 01/18/2023]
Abstract
The HLA B*58:01 allele has been worldwide reported as a pharmacogenetic susceptibility to allopurinol-induced severe cutaneous adverse reactions (SCARs). To prevent these life-threatening conditions, the American College of Rheumatology hingly recommended that the HLA-B*58:01 be screened prior to the initiation of allopurinol therapy. Therefore, we developed a rapid, robust, inexpensive screening method using SYBR® Green real time PCR to detect the HLA-B*58:01 allele. A total of 119 samples were tested. The assay has a sensitivity of 100% (95% CI: 69.15%-100%), a specificity of 100% (95% CI: 96.67%-100%), a positive predictive value of 100% (95% CI: 69.15%-100%) and a negative predictive value of 100% (95% CI: 96.67%-100%). HLA-B*58:01 genotyping results showed 100% agreement with those obtained from Luminex SSO/SBT/SSP. The lowest limit of detection of this method is 0.8 ng/µL of DNA. The unit cost of the test is only $3.8 USD. This novel screening test using SYBR® real time PCR would be appropriate to identify individuals with the HLA-B*58:01 allele for the prevention of allopurinol-induced SCARs.
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Affiliation(s)
- Dinh Van Nguyen
- Sydney Medical School - Northern, University of Sydney, Sydney, Australia.,ImmunoRheumatology Laboratory, Pathology North-Northern Sydney, St Leonards, Australia.,Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi, Vietnam.
| | - Christopher Vida
- ImmunoRheumatology Laboratory, Pathology North-Northern Sydney, St Leonards, Australia.
| | - Hieu Chi Chu
- Center of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi, Vietnam
| | - Richard Fulton
- ImmunoRheumatology Laboratory, Pathology North-Northern Sydney, St Leonards, Australia
| | - Jamma Li
- ImmunoRheumatology Laboratory, Pathology North-Northern Sydney, St Leonards, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
| | - Suran L Fernando
- Sydney Medical School - Northern, University of Sydney, Sydney, Australia.,ImmunoRheumatology Laboratory, Pathology North-Northern Sydney, St Leonards, Australia.,Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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Nguyen DV, Vidal C, Chu HC, Do NTQ, Tran TTL, Le HTM, Fulton RB, Li J, Fernando SL. Validation of a novel real-time PCR assay for detection of HLA-B*15:02 allele for prevention of carbamazepine – Induced Stevens-Johnson syndrome/Toxic Epidermal Necrolysis in individuals of Asian ancestry. Hum Immunol 2016; 77:1140-1146. [DOI: 10.1016/j.humimm.2016.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 11/28/2022]
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