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Belmont AP, Rosano J, Criscione J, Stone CA, Leeds S. When leuprolide acetate is essential to care: A review of the literature and framework for assessing drug allergy. J Allergy Clin Immunol Glob 2024; 3:100210. [PMID: 38433860 PMCID: PMC10906521 DOI: 10.1016/j.jacig.2024.100210] [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] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/12/2023] [Accepted: 12/07/2023] [Indexed: 03/05/2024]
Abstract
Gonadotropin-releasing hormone agonists are uncommonly associated with hypersensitivity reactions. To date, there have been few reports of these cases by allergists and no clear published protocols on testing. Here, we report the case of a patient who had a potential reaction to leuprolide acetate depot and a framework for assessing for drug hypersensitivity with the available literature in mind.
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Affiliation(s)
- Ami P Belmont
- Section of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | - June Criscione
- Combined Medicine-Pediatrics Residency Program, Yale New Haven Hospital, and the Departments of Medicine and Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Cosby A Stone
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Stephanie Leeds
- Department of Pediatrics, Yale School of Medicine, New Haven, Conn
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2
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Bourdonnet V, Dupire G, Calugareanu A, Boibieux A, Ben Said B. Ceftaroline-induced DRESS syndrome associated with possible lung involvement. Contact Dermatitis 2024; 90:423-426. [PMID: 38146813 DOI: 10.1111/cod.14461] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/27/2023]
Affiliation(s)
- V Bourdonnet
- Severe Cutaneous Drug Reaction Regional Center, Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon, Inserm U851, Université Claude Bernard Lyon 1, Lyon Cedex, France
| | - G Dupire
- Clinical Immunology and Allergology Department, CHU Brugmann, Brussels, Belgium
| | - A Calugareanu
- Severe Cutaneous Drug Reaction Regional Center, Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon, Inserm U851, Université Claude Bernard Lyon 1, Lyon Cedex, France
| | | | - Benoit Ben Said
- Severe Cutaneous Drug Reaction Regional Center, Dermatology Department, CHU Lyon Centre, Hospices Civils de Lyon, Inserm U851, Université Claude Bernard Lyon 1, Lyon Cedex, France
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3
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Bragança M, Brandão Abreu D, Moço Coutinho R, Rodrigues Cernadas J, Carneiro-Leão L. Multiple drug hypersensitivity syndrome manifesting as acute generalised exanthematous pustulosis: A rare case report. Contact Dermatitis 2024; 90:439-441. [PMID: 38234058 DOI: 10.1111/cod.14502] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Affiliation(s)
- Mariana Bragança
- Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Daniela Brandão Abreu
- Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ricardo Moço Coutinho
- Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Josefina Rodrigues Cernadas
- Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Unit of Allergy and Clinical Immunology, Hospital Lusíadas Porto, Porto, Portugal
| | - Leonor Carneiro-Leão
- Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Erickson KA, Norton JE, Law J, Soriano N, Strojny M, Gentry N, Fried M, Bochner BS, Kircher S, Stevens WW. Prevention of allergic reactions during oxaliplatin desensitization through inhibition of Bruton tyrosine kinase. J Allergy Clin Immunol 2024:S0091-6749(24)00294-X. [PMID: 38521096 DOI: 10.1016/j.jaci.2024.03.010] [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: 11/23/2023] [Revised: 02/02/2024] [Accepted: 03/02/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Acute infusion reactions to oxaliplatin, a chemotherapeutic used to treat gastrointestinal cancers, are observed in about 20% of patients. Rapid drug desensitization (RDD) protocols often allow the continuation of oxaliplatin in patients with no alternative options. Breakthrough symptoms, including anaphylaxis, can still occur during RDD. OBJECTIVE Our aim was to evaluate whether pretreatment with acalabrutinib, a Bruton tyrosine kinase inhibitor, can prevent anaphylaxis during RDD in a patient sensitized to oxaliplatin. METHODS A 52-year-old male with locally advanced gastric carcinoma developed anaphylaxis during his fifth cycle of oxaliplatin. As he required 6 additional cycles to complete his curative-intent treatment regimen, he underwent RDD to oxaliplatin but still developed severe acute reactions. The risks and benefits of adding acalabrutinib before and during RDD were reviewed, and the patient elected to proceed. RESULTS With acalabrutinib taken before and during the RDD, the patient was able to tolerate oxaliplatin RDD without complication. Consistent with its mechanism of action, acalabrutinib completely blocked the patient's positive skin prick response to oxaliplatin. Acalabrutinib did not alter the percentage of circulating basophils (1.24% vs 0.98%) before the RDD but did protect against basopenia (0.74% vs 0.09%) after the RDD. Acalabrutinib was associated with a drastic reduction in the ability of basophils to upregulate CD63 in vitro following incubation with oxaliplatin (0.11% vs 2.38%) or polyclonal anti-human IgE antibody (0.08% vs 44.2%). CONCLUSIONS Five doses of acalabrutinib, 100 mg, orally twice daily starting during the evening 2 days before and continuing through RDD allowed a sensitized patient to receive oxaliplatin successfully and safely.
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Affiliation(s)
| | - James E Norton
- Division of Allergy and Immunology, Northwestern Medicine, Chicago, Ill
| | - Jennifer Law
- Department of Pharmacy, Northwestern Medicine, Chicago, Ill
| | - Nicole Soriano
- Department of Pharmacy, Northwestern Medicine, Chicago, Ill
| | | | - Nicole Gentry
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Morgan Fried
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Bruce S Bochner
- Division of Allergy and Immunology, Northwestern Medicine, Chicago, Ill
| | - Sheetal Kircher
- Division of Hematology and Oncology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Whitney W Stevens
- Division of Allergy and Immunology, Northwestern Medicine, Chicago, Ill.
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Guyénard L, Tauber M, Debord-Peguet S, Berard F, Nosbaum A, Hacard F, Castells M, Nicolas JF. Case Report: Mast cell anergy: absence of symptoms after accidental re-exposure to amoxicillin/clavulanic acid 3 days after anaphylaxis. Front Allergy 2024; 5:1366922. [PMID: 38529125 PMCID: PMC10961332 DOI: 10.3389/falgy.2024.1366922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/22/2024] [Indexed: 03/27/2024] Open
Abstract
Empty mast cell syndrome, also named post anaphylaxis mast cell anergy (PAMA), is a temporary state of loss of mast cell responsiveness after a severe immediate hypersensitivity reaction. In this study, we describe a case of PAMA after accidental re-exposure to amoxicillin in a patient who developed severe anaphylaxis to this drug three days earlier in the operating room. To our knowledge, this report is the second to document this phenomenon.
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Affiliation(s)
- Loris Guyénard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Marie Tauber
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Sophie Debord-Peguet
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
- Service d’Anesthésie-Réanimation Civilo-Militaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Berard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Audrey Nosbaum
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Florence Hacard
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
| | - Mariana Castells
- Drug Hypersensitivity and Desensitization Center, Mastocytosis Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Jean-François Nicolas
- Allergologie et Immunologie Clinique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Lyon, France
- TeamEpidermal Immunity and Allergy, Centre International de Recherche en Infectiologie (CIRI)—Université Claude Bernard Lyon 1—Inserm U1111—CNRS—ENS, Lyon, France
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Han N, Oh OH, Oh J, Kim Y, Lee Y, Cha WC, Yu YM. The Application of Knowledge-Based Clinical Decision Support Systems to Detect Antibiotic Allergy. Antibiotics (Basel) 2024; 13:244. [PMID: 38534679 DOI: 10.3390/antibiotics13030244] [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: 02/06/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/28/2024] Open
Abstract
Prevention of drug allergies is important for patient safety. The objective of this study was to evaluate the outcomes of antibiotic allergy-checking clinical decision support system (CDSS), K-CDSTM. A retrospective chart review study was performed in 29 hospitals and antibiotic allergy alerts data were collected from May to August 2022. A total of 15,535 allergy alert cases from 1586 patients were reviewed. The most frequently prescribed antibiotics were cephalosporins (48.5%), and there were more alerts of potential cross-reactivity between beta-lactam antibiotics than between antibiotics with the same ingredients or of the same class. Regarding allergy symptoms, dermatological disorders were the most common (38.8%), followed by gastrointestinal disorders (28.4%). The 714 cases (4.5%) of immune system disorders included 222 cases of anaphylaxis and 61 cases of severe cutaneous adverse reactions. Alerts for severe symptoms were reported in 6.4% of all cases. This study confirmed that K-CDS can effectively detect antibiotic allergies and prevent the prescription of potentially allergy-causing antibiotics among patients with a history of antibiotic allergies. If K-CDS is expanded to medical institutions nationwide in the future, it can prevent an increase in allergy recurrence related to drug prescriptions through cloud-based allergy detection CDSSs.
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Affiliation(s)
- Nayoung Han
- Jeju Research Institute of Pharmaceutical Sciences, College of Pharmacy, Jeju National University, Jeju 63243, Republic of Korea
| | - Ock Hee Oh
- FirstDIS Ltd., Seoul 07343, Republic of Korea
| | - John Oh
- Kakao Healthcare Corp., Seongnam 13529, Republic of Korea
| | - Yoomi Kim
- Korea Health Information Service, Seoul 04512, Republic of Korea
| | - Younghee Lee
- Department of Pharmacy, Ajou University Hospital, Suwon 16499, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Yun Mi Yu
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, College of Pharmacy, Yonsei University, Incheon 21983, Republic of Korea
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7
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Li L, Chang Y, Smith NA, Losina E, Costenbader KH, Laidlaw TM. Nonsteroidal anti-inflammatory drug "allergy" labeling is associated with increased postpartum opioid utilization. J Allergy Clin Immunol 2024; 153:772-779.e4. [PMID: 38040042 PMCID: PMC10939859 DOI: 10.1016/j.jaci.2023.11.025] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Current guidelines recommend a stepwise approach to postpartum pain management, beginning with acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), with opioids added only if needed. Report of a prior NSAID-induced adverse drug reaction (ADR) may preclude use of first-line analgesics, despite evidence that many patients with this allergy label may safely tolerate NSAIDs. OBJECTIVE We assessed the association between reported NSAID ADRs and postpartum opioid utilization. METHODS We performed a retrospective cohort study of birthing people who delivered within an integrated health system (January 1, 2017, to December 31, 2020). Study outcomes were postpartum inpatient opioid administrations and opioid prescriptions at discharge. Statistical analysis was performed on a propensity score-matched sample, which was generated with the goal of matching to the covariate distributions from individuals with NSAID ADRs. RESULTS Of 38,927 eligible participants, there were 883 (2.3%) with an NSAID ADR. Among individuals with reported NSAID ADRs, 49.5% received inpatient opioids in the postpartum period, compared to 34.5% of those with no NSAID ADRs (difference = 15.0%, 95% confidence interval 11.4-18.6%). For patients who received postpartum inpatient opioids, those with NSAID ADRs received a higher total cumulative dose between delivery and hospital discharge (median 30.0 vs 22.5 morphine milligram equivalents [MME] for vaginal deliveries; median 104.4 vs 75.0 MME for cesarean deliveries). The overall proportion of patients receiving an opioid prescription at the time of hospital discharge was higher for patients with NSAID ADRs compared to patients with no NSAID ADRs (39.3% vs 27.2%; difference = 12.1%, 95% confidence interval 8.6-15.6%). CONCLUSION Patients with reported NSAID ADRs had higher postpartum inpatient opioid utilization and more frequently received opioid prescriptions at hospital discharge compared to those without NSAID ADRs, regardless of mode of delivery.
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Affiliation(s)
- Lily Li
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Yuchiao Chang
- Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Mass
| | - Nicole A Smith
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Elena Losina
- Harvard Medical School, Boston, Mass; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Mass
| | - Karen H Costenbader
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Inflammation, and Immunity, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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Alqahtani AH, Jagpal P, Kudagammana T, Vedanthan PK, Krishnamurthy K, Hariharan S, El Shabrawy Mohamed Ali RM, Maharaj SB, Marriott JF, Krishna MT. Drug allergy management in Egypt, Sri Lanka and the Caribbean: A qualitative study. Clin Exp Allergy 2024; 54:231-233. [PMID: 38082508 DOI: 10.1111/cea.14437] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Abdulaziz H Alqahtani
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia
| | - Parbir Jagpal
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Thushara Kudagammana
- Faculty of Medicine, University of Peradeniya, and Teaching hospital, Peradeniya, Sri Lanka
| | | | - Kandamaran Krishnamurthy
- The Queen Elizabeth Hospital, The University of West Indies, and ARS Medicae, Barbados, West Indies
| | - Seetharaman Hariharan
- Anaesthesia & Critical Care Medicine, The University of the West Indies, St. Augustine, Trinidad, West Indies
| | | | - Sandeep B Maharaj
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - John F Marriott
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham and Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundations Trust, Birmingham, UK
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Liccioli G, Tomei L, Pessina B, Caubet JC, Barni S, Giovannini M, Sarti L, Mori F. The importance of clinical history in the diagnosis of drug hypersensitivity in children. Pediatr Allergy Immunol 2024; 35:e14091. [PMID: 38444175 DOI: 10.1111/pai.14091] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND In case of suspected hypersensitivity reactions (HRs) to drugs, a challenging area for pediatricians is detecting relevant elements in the parent-reported history, in order to reach a definite diagnosis. We analyzed the concordance between the description of the HR and the medical reports documented at the time of the event. Furthermore, we studied any correlation between clinical history variables and the prediction of true allergy. METHODS We retrospectively collected 50 charts of children referred to our Allergy Unit, after a previous access to the Emergency Department. We compared the description of the HR at acute phase to the history told by parents. Type and timing of the HR and culprit drug were classified as "known" or "unknown." The diagnosis was confirmed or excluded at the end of the investigations. Logistic regression analysis was performed to find any significant association. RESULTS The type of the HR was known in 74%, the timing in 28%, and the culprit drug in 98%. We showed that having had a severe HR had an increased odds of remembering the timing; being older >6 years and having had an immediate HR had an increased odds of remembering the type; time to diagnostic was lower in patients whose parents remembered the type of HR. CONCLUSION Our paper underlines the importance of an accurate anamnesis at the time of the event. Providing the physicians with a standardized Case Report Form could be a useful tool to simplify the diagnostic work-up and minimize mistakes due to lack of memory.
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Affiliation(s)
- Giulia Liccioli
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Leonardo Tomei
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Benedetta Pessina
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Jean-Christoph Caubet
- Pediatric Allergy Unit, Department of Women, Children and Adolescents, University Hospital of Geneva, Geneva, Switzerland
| | - Simona Barni
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Mattia Giovannini
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Lucrezia Sarti
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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Doña I, Torres MJ, Celik G, Phillips E, Tanno LK, Castells M. Changing patterns in the epidemiology of drug allergy. Allergy 2024; 79:613-628. [PMID: 38084822 DOI: 10.1111/all.15970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 07/11/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 03/01/2024]
Abstract
Drug allergy (DA) remains a complex and unaddressed problem worldwide that often deprives patients of optimal medication choices and places them at risk for life-threatening reactions. Underdiagnosis and overdiagnosis are common and due to the lack of standardized definitions and biomarkers. The true burden of DA is unknown, and recent efforts in data gathering through electronic medical records are starting to provide emerging patterns around the world. Ten percent of the general population engaged in health care claim to have a DA, and the most common label is penicillin allergy. Up to 20% of emergency room visits for anaphylaxis are due to DA and 15%-20% of hospitalized patients report DA. It is estimated that DA will increase based on the availability and use of new and targeted antibiotics, vaccines, chemotherapies, biologicals, and small molecules, which are aimed at improving patient's options and quality of life. Global and regional variations in the prevalence of diseases such as human immunodeficiency virus and mycobacterial diseases, and the drugs used to treat these infections have an impact on DA. The aim of this review is to provide an update on the global impact of DA by presenting emerging data on drug epidemiology in adult and pediatric populations.
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Affiliation(s)
- Immaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Malaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Maria Jose Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Malaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
- Departamento de Medicina, Universidad de Málaga, Malaga, Spain
| | - Gulfem Celik
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Elizabeth Phillips
- Department of Medicine, Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier-INSERM, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Fernández-Bravo S, Betancor D, Cuesta-Herranz J, Rodríguez del Río P, Ibañez-Sandín MD, Nuñez-Borque E, Esteban V. Circulating serum profile of small non-coding RNAs in patients with anaphylaxis beyond microRNAs. Front Allergy 2024; 5:1307880. [PMID: 38384772 PMCID: PMC10879566 DOI: 10.3389/falgy.2024.1307880] [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: 10/05/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Anaphylaxis is the most severe manifestation of allergic disorders. Currently, an increasing number of cells, pathways and molecules involved in the etiopathogenesis of anaphylaxis are being discovered. However, there are no conclusive biomarkers to confirm its diagnosis. Small non-coding RNAs (sncRNAs) are 18-200 nucleotide molecules that can be divided into: microRNAs (miRNAs), Piwi-interacting RNAs (piRNAs), small nucleolar RNAs (snoRNAs), small nuclear RNAs (snRNAs), transference RNA derived fragments (tRFs) and YRNA derived fragments (YRFs). These molecules participate in cell-cell communication modulating various physiological processes and have been postulated as non-invasive biomarkers of several pathologies. Therefore, in this study we characterized the serum circulating profile of other sncRNA beyond miRNAs in two populations of 5 adults and 5 children with drug- and food-mediated anaphylaxis, respectively. Methods Samples were obtained from each patient under two different conditions: during anaphylaxis and 14 days after the reaction (control). The sncRNA analysis was carried out by Next Generation Sequencing (NGS). Results A total of 671 sncRNAs (3 piRNAs, 74 snoRNAs, 54 snRNAs, 348 tRFs and 192 YRFs) were identified in adults with drug-induced anaphylaxis, while 612 sncRNAs (2 piRNAs, 73 snoRNAs, 52 snRNAs, 321 tRFs and 164 YRFs) were characterized in children with food-mediated anaphylaxis. However, only 33 (1 piRNA, 4 snoRNAs, 1 snRNAs, 7 tRFs and 20 YRFs) and 80 (4 snoRNAs, 6 snRNAs, 54 tRFs and 16 YRFs) of them were statistically different between both conditions, respectively. Among them, only three (Y_RNA.394, Y_RNA.781 and SCARNA2) were common to both adults and children analysis. Discussion This study provides a differential profile of circulating serum sncRNAs beyond miRNAs in patients with anaphylaxis, postulating them as candidate biomarkers for this pathological event and as novel mediators of the reaction.
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Affiliation(s)
| | - Diana Betancor
- Allergy Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Pablo Rodríguez del Río
- Allergy Department, Hospital Infantil Universitario Niño Jesús, Fundación HNJ, IIS-P, Madrid, Spain
| | | | - Emilio Nuñez-Borque
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
- Faculty of Medicine and Biomedicine, Alfonso X El Sabio University, Madrid, Spain
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Tuesuwan B, Buranapraditkun S, Arjharn W, Suthumchai N, Chongpison Y, Klaewsongkram J. Immunogenicity of cephalosporin components in non-IgE-mediated cephalosporin allergy. Clin Exp Allergy 2024; 54:156-158. [PMID: 38010885 DOI: 10.1111/cea.14429] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Bodin Tuesuwan
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Supranee Buranapraditkun
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Weena Arjharn
- Department of Food and Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Nithikan Suthumchai
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yuda Chongpison
- Biostatistics Excellence Center, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
| | - Jettanong Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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13
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Dagher J, Antonios D, Chollet-Martin S, de Chaisemartin L, Pallardy M, Azouri H, Irani C. Drug-induced hypersensitivity reactions in a Lebanese outpatient population: A decade-long retrospective analysis (2012-2021). J Allergy Clin Immunol Glob 2024; 3:100169. [PMID: 37876854 PMCID: PMC10590748 DOI: 10.1016/j.jacig.2023.100169] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/26/2023]
Abstract
Background Drug hypersensitivity reactions (DHRs) are becoming more common as a result of increasing prevalence and case complexity. Allergists and clinical immunologists worldwide are challenged daily to adequately diagnose and manage these reactions. Data in the literature regarding DHR outpatient consultations are scarce worldwide, limited in the Middle East, and currently unavailable in Lebanon. Objective This retrospective study aimed to evaluate the characteristics of all reported DHRs over 10 years in a tertiary-care allergy clinic in Lebanon. Methods We conducted a decade-long (2012-21) retrospective analysis of the archived medical records of patients with a history of DHRs. Demographics, clinical history, diagnostic tools, and characteristics of the DHRs were collected and analyzed. Results A total of 758 patients experienced DHRs to therapeutic molecules provided for ambulatory care. Our results identified 72 medications. The most frequently implicated drug classes included β-lactam antibiotics (53.8%), followed closely by nonsteroidal anti-inflammatory drugs (48.9%). Of the 758 patients, 32.6% reported DHRs to multiple molecules, and 11.8% reported concomitant DHRs to 1 or several molecules provided in the perioperative setting. Of those, opioids and neuromuscular blocking agents were the 2 most common therapeutic classes. Furthermore, we evaluated the cross-reactivity between molecules of the same class. In neuromuscular blocking agents, rocuronium and cisatracurium were the most commonly cross-reactive, and for opioids, the most common association we recorded was with morphine and pethidine. Conclusion Our findings constitute the first step toward a more comprehensive evaluation of the clinical characteristics of DHRs in Lebanon.
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Affiliation(s)
- Joelle Dagher
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Diane Antonios
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Sylvie Chollet-Martin
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Luc de Chaisemartin
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Marc Pallardy
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Hayat Azouri
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, University Medical Center Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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14
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Caliskan N, Yildirim G, Bologur H, Gungor H, Karaca Sahin M, Erbay F, Kokcu Karadag Sİ, Ozceker D. Local anesthetics allergy in children: Evaluation of diagnostic tests with Real-Life data. Pediatr Allergy Immunol 2024; 35:e14097. [PMID: 38404118 DOI: 10.1111/pai.14097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Local anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis. METHODS January 2017-July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated. RESULTS Our study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non-LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine. CONCLUSION Although LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.
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Affiliation(s)
- Nilay Caliskan
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Guler Yildirim
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Hamit Bologur
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Hilal Gungor
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Merve Karaca Sahin
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Fatih Erbay
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | | | - Deniz Ozceker
- Department of Pediatric Allergy and Immunology, Prof.Dr.Cemil Tascıoglu City Hospital, Istanbul, Turkey
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15
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Cakmak ME. Successful treatment using agalsidase alfa of a patient with Fabry disease who had anaphylaxis after agalsidase beta: A case report. North Clin Istanb 2024; 11:88-90. [PMID: 38357316 PMCID: PMC10861426 DOI: 10.14744/nci.2022.45656] [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: 06/28/2022] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Fabry disease is a rare genetic disease caused by a deficiency of α-galactosidase A gene (α-Gal A). Two intravenous enzymes administered every two weeks, agalsidase alfa and beta can slow disease progression and increase survival if administered early, before organ damage occurs. In this case report, we present a patient with a history of anaphylaxis to agalsidase beta who was successfully treated with agalsidase alfa.
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Affiliation(s)
- Mehmet Erdem Cakmak
- Department of Allergy and Clinical Immunology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkiye
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16
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Kawanami A, Miyashita M, Miyagi Y, Hasegawa K. [A 70-year-old male exhibiting parkinsonism-hyperpyrexia syndrome during levodopa carbidopa intestinal gel (LCIG) treatment and suspected carbidopa allergy due to positive drug-induced lymphocyte stimulation test (DLST)]. Rinsho Shinkeigaku 2024; 64:17-22. [PMID: 38092414 DOI: 10.5692/clinicalneurol.cn-001883] [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] [Indexed: 01/23/2024]
Abstract
A 70-year-old male who has medical history of Parkinson's disease for 26 years admitted to our hospital for trial of levodopa carbidopa intestinal gel (LCIG) therapy because of severe dyskinesia and frequent wearing-off. He developed deterioration when he was treated with one of the levodopa (LD) decacrboxylase inhibitor compounds in the past. Five days after LD had changed into equivalent dose of LD/carbidopa (CD), high fever with hyperCKemia appeared. He was diagnosed as having Parkinsonism-hyperpyrexia syndrome (PHS). Exchange of LD/CD to LD drugs improved the symptoms quickly. Four days after LCIG administration, PHS reappeared. Simultaneously, the patient developed sepsis and disseminated intravascular coagulation (DIC). Thrombocytopenia did not improve after recovery from infection and DIC. Anti-PA IgG and drug-induced lymphocyte stimulation test (DLST) against LCIG showed positive. Exchange of LCIG to LD drugs and intravenous methylprednisolone administration improved the symptoms and thrombocytopenia. CD induced type II and type IV allergy were suspected. This case offers a caution that physicians should be aware of drug allergy in cases of which unexpected symptoms occurred in altering one LD compound to another.
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Affiliation(s)
- Aya Kawanami
- Department of Neurology, National Hospital Organization, Sagamihara National Hospital
| | - Masanobu Miyashita
- Department of Neurology, National Hospital Organization, Sagamihara National Hospital
| | - Yuichi Miyagi
- Department of Neurology, National Hospital Organization, Sagamihara National Hospital
| | - Kazuko Hasegawa
- Department of Neurology, National Hospital Organization, Sagamihara National Hospital
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17
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Kan AKC, Chiang V, Saha C, Au EYL, Li PH. Feasibility of a drug allergy registry-based excipient allergy database and call for universal mandatory drug ingredient disclosure: the case of PEG. Front Allergy 2024; 4:1331036. [PMID: 38292585 PMCID: PMC10824824 DOI: 10.3389/falgy.2023.1331036] [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: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024] Open
Abstract
Background Excipient allergy is a rare, but potentially lethal, form of drug allergy. Diagnosing excipient allergy remains difficult in regions without mandatory drug ingredient disclosure and is a significant barrier to drug safety. Objective To investigate the feasibility of a drug allergy registry-based excipient database to identify potential excipient culprits in patients with history of drug allergy, using polyethylene glycol (PEG) as an example. Methods An excipient registry was created by compiling the excipient lists pertaining to all available formulations of the top 50 most reported drug allergy culprits in Hong Kong. Availability of excipient information, and its relationship with total number of formulations of individual drugs were analysed. All formulations were checked for the presence or absence of PEG. Results Complete excipient information was available for 36.5% (729/2,000) of all formulations of the top 50 reported drug allergy culprits in Hong Kong. The number of formulations for each drug was associated with proportion of available excipient information (ρ = 0.466, p = 0.001). Out of 729 formulations, 109 (15.0%) and 620 (85.0%) were confirmed to contain and not contain PEG, respectively. Excipient information was not available for the other 1,271 (63.6%) formulations. We were unable to confirm the presence or absence of PEG in any of the top 50 drug allergy culprits in Hong Kong. Conclusion In countries without mandatory drug ingredient disclosure, excipient databases are unlikely able to identify potential excipient allergy in drug allergy patients. Legislations to enforce mandatory and universal ingredient disclosure are urgently needed.
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Affiliation(s)
- Andy Ka Chun Kan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Valerie Chiang
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Chinmoy Saha
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Elaine Y. L. Au
- Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
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18
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Franceschini F, Bottau P, Caimmi S, Bianchi A, Crisafulli G, Liotti L, Mori F, Riscassi S, Saretta F, Valluzzi RL, Caffarelli C. Local Anesthetic Hypersensitivity Reactions in Pediatric Patients: Recognition and Management. Discov Med 2024; 36:16-21. [PMID: 38273743 DOI: 10.24976/discov.med.202436180.2] [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] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Local anesthetics (LAs) are commonly used in all medical specialties, particularly in association with surgery, obstetrics, dentistry, and emergency departments. Most individuals, starting from young children, are exposed to LAs during life. LA hardly induces adverse events when used in recommended doses and with proper injection techniques. However, immediate anaphylactic reactions to LA injections may be a rare but life-threatening manifestation. A comprehensive report of the event and performing a specialist examination are crucial to prevent further episodes. The diagnosis should be based on history, medical records, skin and challenge tests.
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Affiliation(s)
| | - Paolo Bottau
- Pediatric and Neonatology Unit, Imola Hospital, 40026 Imola, Italy
| | - Silvia Caimmi
- Clinica Pediatrica Unit, San Matteo Hospital, University di Pavia, 27100 Pavia, Italy
| | | | - Giuseppe Crisafulli
- Allergology Unit, Pediatric Department, University of Messina, 98122 Messina, Italy
| | - Lucia Liotti
- Pediatric Unit, Salesi Hospital, 60100 Ancona, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, 50139 Florence, Italy
| | - Sara Riscassi
- Pediatric Department, Bolzano Hospital, 39100 Bolzano, Italy
| | - Francesca Saretta
- Pediatric Unit, Latisana-Palmanova Hospital, Pediatric Department, Azienda Sanitaria, Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Rocco Luigi Valluzzi
- Allergology Unit, Pediatric Department, Bambino Gesu' Pediatric Hospital, 00165 Roma, Italy
| | - Carlo Caffarelli
- Clinica Pediatrica Unit, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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19
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Pholmoo N, Thaiwat S, Klaewsongkram J. Severe vitamin D deficiency increases the risk of severe cutaneous adverse reactions. Exp Dermatol 2024; 33:e14980. [PMID: 37965883 DOI: 10.1111/exd.14980] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023]
Abstract
Vitamin D deficiency has been reported to be associated with allergic diseases and dermatological disorders. We investigated the role of vitamin D in drug-induced non-immediate hypersensitivity reactions by measuring serum vitamin D levels in 60 patients diagnosed with non-immediate drug hypersensitivity reactions and in 60 patients who tolerated the same medication without any allergic reactions. The results showed that serum vitamin D levels were significantly lower in patients with severe cutaneous adverse reactions (SCARs) (13.56 ± 6.23 ng/mL) compared to patients with mild reactions (17.50 ± 7.49 ng/mL) and the drug-tolerant control group (17.42 ± 7.28 ng/mL), with p values of 0.031 and 0.015, respectively. The proportion of severe vitamin D deficiency (< 10 ng/mL) was much higher in SCAR patients compared to drug-tolerant subjects (36.7% vs. 11.7%, p value = 0.005). After adjusting for age, gender, region of residence, and concurrent illnesses, patients with severe vitamin D deficiency had significantly increased in-hospital mortality (odds ratio 16.04; 95% CI, 1.25-206.12, p value = 0.03). In conclusion, the risk of developing SCARs and in-hospital mortality was increased in patients with severe vitamin D deficiency. Further investigations should be conducted to elucidate the role of vitamin D in the development of SCARs.
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Affiliation(s)
- Natthiya Pholmoo
- Division of Allergy and Clinical Immunology, Department of medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Supitchaya Thaiwat
- Department of Medicine, Division of Dermatology, Phramongkutklao Hospital, Bangkok, Thailand
| | - Jettanong Klaewsongkram
- Division of Allergy and Clinical Immunology, Department of medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Skin and Allergy Research Unit, Chulalongkorn University, Bangkok, Thailand
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20
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Ruano-Zaragoza M, Torrent-Rodríguez A, Araujo-Sanchez G, Ribó P, Loli-Ausejo D, Solis K, Sánchez-Fernández MC, Bolaños J, Bolós U, López C, Ruiz S, Pascal M, Bartra J, Muñoz-Cano R. Successful Oral Dasatinib Desensitization in Immediate Hypersensitivity. J Investig Allergol Clin Immunol 2023; 34:0. [PMID: 38131221 DOI: 10.18176/jiaci.0985] [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] [Indexed: 12/23/2023] Open
Affiliation(s)
- M Ruano-Zaragoza
- Allergy Department, Hospital Clinic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- RETIC Asma, Reacciones Adversas y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | | | - G Araujo-Sanchez
- Allergy Department, Hospital Clinic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- RETIC Asma, Reacciones Adversas y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - P Ribó
- Allergy Department, Hospital Clinic, Barcelona, Spain
| | - D Loli-Ausejo
- Allergy Department, Hospital Clinic, Barcelona, Spain
| | - K Solis
- Allergy Department, Hospital Clinic, Barcelona, Spain
| | | | - J Bolaños
- Immunology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - U Bolós
- Immunology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | - M Pascal
- RETIC Asma, Reacciones Adversas y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Madrid, Spain
- Immunology Department, Centre de Diagnòstic Biomèdic (CDB), Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Bartra
- Allergy Department, Hospital Clinic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- RETIC Asma, Reacciones Adversas y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Madrid, Spain
| | - R Muñoz-Cano
- Allergy Department, Hospital Clinic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, Institut Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- RETIC Asma, Reacciones Adversas y Alergia (ARADyAL) and RICORS Red de Enfermedades Inflamatorias (REI), Madrid, Spain
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21
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Chang SL, Lai CH, Lin GC, Chen YM, Lee MH, Hsu HS, Chen IC. Genetic Susceptibility of HLA Alleles to Non-Steroidal Anti-Inflammatory Drug Hypersensitivity in the Taiwanese Population. Biomedicines 2023; 11:3273. [PMID: 38137494 PMCID: PMC10741656 DOI: 10.3390/biomedicines11123273] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Human leukocyte antigen (HLA) genes are important in many immune processes and contribute to many adverse drug reactions. Whether genetic variations in the HLA region are associated with non-steroid anti-inflammatory drug (NSAID) hypersensitivity remains uncertain. Therefore, the aim of our study was to identify HLA genetic variations in patients with NSAID hypersensitivity in the Taiwanese population. METHODS This hospital-based, retrospective case-control study enrolled 37,156 participants with NSAID exposure from the Taiwan Precision Medicine Initiative (TPMI), who were all genotyped and imputed to fine map HLA typing. Our study assigned 1217 cases to the NSAID allergy group and 12,170 controls to a matched group. Logistic regression analyses were utilized to explore associations between HLA alleles and NSAID hypersensitivity. RESULTS Overall, 13,387 patients were genotyped for eight major HLA alleles. Allele frequencies were different between the two groups. In the NSAID allergy group, the genotype frequencies of HLA-A*02:01, HLA-A*34:01, and HLA-DQA1*06:01 were found to be markedly elevated compared to the control group, a significance that persisted even after applying the Bonferroni correction. Furthermore, the risk of NSAID allergy demonstrated a significant association with HLA-A*02:01 (OR = 1.29, p < 0.001) and HLA-A*34:01 (OR = 9.90, p = 0.001), in comparison to their respective counterparts. Notably, the genotype frequency of HLA-B*46:01 exhibited a significant increase in the severe allergy group when compared with the mild allergy group. CONCLUSIONS We identified HLA genotypes linked to the onset and severity of NSAID hypersensitivity. Our findings establish a basis for precision prescription in future clinical applications.
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Affiliation(s)
- Szu-Ling Chang
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Department of Postbaccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; (C.-H.L.); (Y.-M.C.)
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chih-Hung Lai
- Department of Postbaccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; (C.-H.L.); (Y.-M.C.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medicine and Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Guan-Cheng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
| | - Yi-Ming Chen
- Department of Postbaccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402202, Taiwan; (C.-H.L.); (Y.-M.C.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
- Division of Allergy, Immunology and Rheumatology, Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 402202, Taiwan
| | - Mei-Hsuan Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei 112201, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung 407219, Taiwan;
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Withers Green J, Vasanthakumar D. Does vitamin D supplementation reduce risk of asthma exacerbation and improve asthma control? Clin Exp Allergy 2023; 53:1239-1242. [PMID: 37804101 DOI: 10.1111/cea.14410] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/23/2023] [Indexed: 10/08/2023]
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23
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Casale TB, Ellis AK, Nowak-Wegrzyn A, Kaliner M, Lowenthal R, Tanimoto S. Pharmacokinetics/pharmacodynamics of epinephrine after single and repeat administration of neffy, EpiPen, and manual intramuscular injection. J Allergy Clin Immunol 2023; 152:1587-1596. [PMID: 37604314 DOI: 10.1016/j.jaci.2023.08.007] [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: 04/13/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Epinephrine is the first-line treatment for severe allergic reactions, and rapid treatment is associated with lower rates of hospitalization and death. Current treatment options (epinephrine auto-injectors and manual intramuscular injection) are considered cumbersome, and most patients/caregivers fail to use them, even during severe reactions. An intranasal epinephrine delivery device, neffy, has been designed to provide an additional option for patients/caregivers. OBJECTIVE We sought to assess the comparative pharmacokinetics and pharmacodynamics of neffy 2.0 mg, EpiPen 0.3 mg, and manual intramuscular injection 0.3 mg. METHODS This was a phase 1, randomized, 6-treatment, 6-period, 2-part crossover study in 59 healthy subjects. Pharmacokinetic and pharmacodynamic parameters following single and repeat doses of epinephrine were assessed before dosing and at various postdose intervals. RESULTS The pharmacokinetic profile of neffy was bracketed by approved injection products, with a mean peak plasma level of 481 pg/mL, which fell between EpiPen (753 pg/mL) and epinephrine manual intramuscular injection (339 pg/mL). When dosed both once and twice, neffy resulted in more pronounced increases in pharmacodynamic parameters relative to EpiPen or manual injection. CONCLUSIONS neffy's pharmacokinetic profile was bracketed by approved injection products, with pharmacodynamic responses that were comparable to or better than approved injection products. neffy is expected to be a safe and effective option, particularly for patients/caregivers who are reluctant to carry and use injection devices.
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Affiliation(s)
- Thomas B Casale
- Morsani College of Medicine, University of South Florida, Tampa, Fla
| | - Anne K Ellis
- Kingston General Health Research Institute, Kingston, Canada
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Xu F, Zhang H, Xiao H, Meng J. Delayed-type allergic reaction to furazolidone: A case report and review of the literature. Contact Dermatitis 2023; 89:496-500. [PMID: 37750438 DOI: 10.1111/cod.14424] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/14/2023] [Accepted: 09/14/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Furazolidone is a nitrofuran antimicrobial agent used in the treatment of bacterial and protozoal infections. Hypersensitivity to furazolidone is rarely reported and only eight cases have been documented in English since 1967. OBJECTIVES To report a 24-year-old man who developed exanthematous drug eruptions in general and swelling sensation of the hands after first dose of oral administration of medicines for Helicobacter pylori infection 7 h later, who was finally confirmed with delayed-type IV allergic reaction to furazolidone by provocation tests. And to review the existing literature. METHODS Thorough clinical examination, prick, intradermal, and patch tests, drug provocation tests were performed in the patient. RESULTS Skin tests of all used drugs were negative. Drug provocation tests to furazolidone resulted to be positive. CONCLUSIONS Clinicians should be aware that furazolidone may induce delayed-type allergic reactions; diagnostic approaches should be taken to identify the responsible drug when multiple medications were used concurrently.
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Affiliation(s)
- Feng Xu
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Hongting Zhang
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Hao Xiao
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
| | - Juan Meng
- Department of Otolaryngology - Head & Neck Surgery/Allergy Center of West China Hospital, Sichuan University, Chengdu, China
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Podlecka D, Jerzyńska J, Brzozowska A. Don't we overestimate drug allergies in children? Int J Occup Med Environ Health 2023; 36:632-642. [PMID: 37750429 DOI: 10.13075/ijomeh.1896.02227] [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] [Indexed: 09/27/2023] Open
Abstract
OBJECTIVES On average about 10% of parents report hypersensitivity to at least 1 drug in their children. After diagnosis process a few of these reactions are being confirmed as drug hypersensitivity reactions. The aim of the study was to assess the real-life prevalence of drug hypersensitivity in children based on drug provocation tests. MATERIAL AND METHODS The authors included 113 children, aged 4-18 years, referred to Pediatrics and Allergy Clinic in Łódź, Poland, due to incidence of adverse reaction during treatment. Medical history regarding allergies to drugs was taken in accordance to the form developed by the United States Food and Drug Administration Adverse Event Reporting System. Skin prick tests, intradermal test and drug provocation test were performed in all patients. RESULTS In all 113 patients suspected of drug allergy, after all diagnostic procedures, the authors proved IgE-mediated allergy to β-lactams, nonsteroid anti-inflammatory drugs, local anesthetics in 19 patients (16.8%). Previous history of allergy was a risk factor for drug allergy in studied patients (p = 0.001). The most frequent symptoms of allergy were urticaria and erythematous papular rash. CONCLUSIONS Drug allergy is a difficult problem in the practice of a doctor and is difficult to diagnose, especially in the pediatric population. It seems that too often isolated symptoms reported during infection or disease are taken as a symptom of drug allergy, and not as a symptom resulting from the course of the disease. Int J Occup Med Environ Health. 2023;36(5):632-42.
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Affiliation(s)
- Daniela Podlecka
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
| | - Joanna Jerzyńska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
| | - Agnieszka Brzozowska
- Medical University of Lodz, Łódź, Poland (Copernicus Memorial Hospital, Department of Pediatrics and Allergy)
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Wolfson A, Ramsey A. Delabeling Drug Allergy on a College Campus. Ann Allergy Asthma Immunol 2023:S1081-1206(23)01474-6. [PMID: 38008217 DOI: 10.1016/j.anai.2023.11.024] [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: 10/04/2023] [Revised: 11/18/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Anna Wolfson
- Harvard Medical School, Boston, MA; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, MA
| | - Allison Ramsey
- Rochester Regional Health, Rochester, NY; Department of Allergy/Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
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Bassir F, Alvarez-Arango S, Kroshinsky D, Phillips E, Ezeofor AJ, Samarakoon U, Blackley SV, Wang L, Zhou L, Blumenthal KG. Drug reaction with eosinophilia and systemic symptoms (DRESS): clinical presentation and outcomes in people of color. J Allergy Clin Immunol Pract 2023; 11:3537-3540. [PMID: 37572756 PMCID: PMC10841067 DOI: 10.1016/j.jaip.2023.08.009] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Fatima Bassir
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Santiago Alvarez-Arango
- Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, Mass; Department of Dermatology, Massachusetts General Hospital, Boston, Mass
| | - Elizabeth Phillips
- Center for Drug Safety and Immunology, Departments of Medicine, Dermatology, Pharmacology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn
| | - Adaeze J Ezeofor
- Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Upeka Samarakoon
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, The Mongan Institute, Massachusetts General Hospital, Boston, Mass
| | - Suzanne V Blackley
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Liqin Wang
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Li Zhou
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Kimberly G Blumenthal
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Department of Medicine, The Mongan Institute, Massachusetts General Hospital, Boston, Mass.
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Bianchi L, Hansel K, Biondi F, Caroppo ES, Galeotti T, Casciola G, Tramontana M, Marietti R, Napolitano M, Patruno C, Stingeni L. Delayed hypersensitivity reactions to iodinated contrast media: A diagnostic approach by skin tests. Contact Dermatitis 2023; 89:352-358. [PMID: 37394777 DOI: 10.1111/cod.14372] [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: 05/25/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Adverse drug reactions to iodinated contrast media (ICM) have risen due to their increasing use in x-ray-based imaging modalities. Delayed hypersensitivity reactions are mainly caused by nonionic monomeric compounds and represent an issue impacting the diagnostic-therapeutic pathways of cancer, cardiology and surgery patients. OBJECTIVES To prospectively evaluate the usefulness of skin tests in delayed hypersensitivity reactions to ICM and to evaluate the tolerability of iobitridol, a monomeric nonionic low osmolality compound, as a possible safe alternative. METHODS Patients with delayed hypersensitivity reactions to ICM referred to us from 2020 to 2022 were prospectively enrolled in the study. All patients underwent patch test and, if negative, intradermal test with the culprit ICM and iobitridol as alternative. RESULTS A total of 37 patients (females 24, 64.9%) were enrolled in the study. Iodixanol and iomeprol were the most frequently involved ICM (48.5% and 35.2%, respectively); 62.2% of patients presented maculopapular eruption, while 37.8% reported delayed urticaria-like rash. Skin tests resulted positive to the culprit ICM in 19 patients (51.4%), 16 to patch test and 3 to intradermal test. Skin tests with iobitridol, tested as alternative, resulted positive in 3/19 patients (15.8%). All 16 patients with negative results to iobitridol were administered this ICM and tolerated it. CONCLUSIONS In at least half of patients, delayed-type hypersensitivity was demonstrated by skin tests, particularly by patch test. This diagnostic approach resulted simple, cost-effective and safe, not only to confirm the culprit ICM but also to identify iobitridol as feasible alternative.
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Affiliation(s)
- Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Sofia Caroppo
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Tommaso Galeotti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Casciola
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Çalişkan N, Coskun R, Bologur H, Yildırım G, Güngör H, Bosnali O, Özçeker D. Treatment of hydatid cyst with albendazole desensitization: A pediatric case report. Indian J Pharmacol 2023; 55:408-409. [PMID: 38174539 PMCID: PMC10821695 DOI: 10.4103/ijp.ijp_301_23] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/11/2023] [Accepted: 10/17/2023] [Indexed: 01/05/2024] Open
Abstract
Albendazole is a benzimidazole group drug used alone or in combination with surgery in the treatment of many helminthiasis, especially hydatid cysts. Type 1 hypersensitivity reaction has been reported rarely. Treatment with desensitization has been successfully applied in a few adult patients, however literature information on pediatric patients was not available. Here, we present a pediatric case in which Type 1 reaction occurred due to the use of albendazole during hydatid cyst treatment and undergone desensitization.
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Affiliation(s)
- Nilay Çalişkan
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Raif Coskun
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Hamit Bologur
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Güler Yildırım
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Hilal Güngör
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Oktav Bosnali
- Department of Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Deniz Özçeker
- Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Ali SB, Le TTA, Ahmadie A, Yuson C, Kette F, Hissaria P, Smith WB. The role of major and minor determinants in penicillin allergy testing: Time to revisit an old friend? J Allergy Clin Immunol Glob 2023; 2:100132. [PMID: 37781672 PMCID: PMC10509867 DOI: 10.1016/j.jacig.2023.100132] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 10/03/2023]
Abstract
Background Skin testing is an important step in evaluation of penicillin allergic reactions. It includes testing to the following: amoxicillin, benzyl penicillin, and products generated in vivo after penicillin administration, the major determinant hapten penicilloyl-polylysine (PPL) and the minor determinant mixture (MDM). Although PPL and MDM are available as a commercial kit, their supply and cost remain problematic. Objective We aimed to evaluate the performance and utility of PPL and MDM in penicillin allergy testing. Methods A retrospective audit over a 5-year period was undertaken for those with penicillin testing in a tertiary immunology unit. Results In all, 214 patients were identified. Of those patients, 151 (70.6%) were female and the average age was 58 years. Unspecified penicillin was the most common index drug (n = 127 [59.3%]), followed by amoxicillin (n =3 [24.8%]) and amoxicillin-clavulanic acid (n = 21 [9.7%]). The result of skin testing was positive in 23 patients (10.7%); skin prick testing was positive in 10 patients (4.7%), and intradermal testing (IDT) was positive in 13 patients (6.1%), the majority of whom had identified amoxicillin or amoxicillin-clavulanic acid as the index drug (n = 22 [95.7%]). The result of testing to PPL and/or MDM was positive with IDT only (n=5 [23.8%]). PPL and MDM positivity coexisted with a positive reaction to amoxicillin IDT in 2 patients, 1 of whom passed an amoxicillin challenge. Additionally, 2 positive tests to PPL were present with a negative result for MDM; of these 2 positive results, 1 was positive to amoxicillin IDT. In only 1 case were the results of testing for MDM and PPL both positive, with negative results to all native β-lactams tested; the patient tolerated an amoxicillin challenge. Overall, the negative predictive value for both skin prick testing and IDT was 89.5%. Conclusion Benzyl penicillin and amoxicillin alone may be sufficient for in vivo testing in suspected individuals with penicillin allergy.
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Affiliation(s)
- Syed B. Ali
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Thanh-Thao Adriana Le
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Aida Ahmadie
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Chino Yuson
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Frank Kette
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
| | - Pravin Hissaria
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
- Department of Immunopathology, SA Pathology, Adelaide, Australia
| | - William B. Smith
- Department of Clinical Immunology and Allergy, Royal Adelaide Hospital, Adelaide, Australia
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Gaspar A, Moura AL, Cruz C, Borrego LM. Polythylene glycol severe allergy and SARS-CoV-2 vaccines: usefulness of testing with PEG 1500 extract. Eur Ann Allergy Clin Immunol 2023; 55:261-270. [PMID: 36458507 DOI: 10.23822/eurannaci.1764-1489.275] [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] [Indexed: 12/04/2022]
Abstract
Summary Background. Polyethylene glycol (PEG) is being used for first time as an excipient for mRNA anti-SARS-CoV-2 vaccines containing PEG 2000, highlighting it as a potential cause of anaphylaxis. Methods. We evaluated 126 patients with moderate-high risk of allergy to SARS-CoV-2 vaccines referred to our department from March-December 2021. Skin tests were performed with PEG 1500 extract (Roxall), using a stepwise approach, with readings at 30 minutes: prick tests with 0.1%, 1% and 10% concentrations; if negative, intradermal tests with 0.0001%, 0.001% and 0.01% concentrations. The same protocol was applied to 5 healthy controls Results. Six patients had positive immediate intradermal tests with PEG 1500, all with severe PEG allergy: one with a near-fatal anaphylaxis after glucocorticoid injection containing PEG 3350 and five with systemic allergic reactions after mRNA vaccines containing PEG 2000 (Pfizer-BioNTech or Moderna). One patient developed anaphylaxis during intradermal test. These six patients were negative to polysorbate 80. The remaining 120 patients had negative tests to PEG 1500; seven had positive tests to polysorbate 80. All controls had negative tests. Conclusions. To our knowledge this is the first study describing the allergy work-up testing with PEG 1500 commercial extract in the scope of SARS-CoV-2 vaccination. The algorithm designed for skin tests revealed to be a useful tool. Severe PEG allergy was diagnosed in 5% of patients, contraindicating PEG-containing vaccines. PEG allergy was excluded in one hundred patients that afterwards took SARS-CoV-2 vaccines containing PEG 2000. Investigation should be conducted in specialized drug allergy centers..
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Affiliation(s)
- A Gaspar
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - A L Moura
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - C Cruz
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
| | - L M Borrego
- Department of Immunoallergy, Hospital da Luz Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School Research, Universidade Nova de Lisboa, Lisbon, Portugal
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Yogi TN, Bhusal A, Kafle R, Labh S, Pokhrel S. Ketorolac-induced anaphylaxis following oral administration: a case series. Ann Med Surg (Lond) 2023; 85:4662-4666. [PMID: 37811072 PMCID: PMC10552976 DOI: 10.1097/ms9.0000000000001156] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Background Ketorolac is a commonly used non-steroidal anti-inflammatory drug for reducing pain and inflammation. Anaphylaxis is a medical emergency that occurs after exposure to an allergen, with a varied clinical presentation requiring prompt and appropriate measures to prevent or manage it. Although uncommon, ketorolac can cause anaphylaxis requiring immediate medical care. The authors present two cases of anaphylaxis in females induced after oral intake of ketorolac with successful outcomes. Case presentations The cases involve two adult women who experienced an allergic reaction to ketorolac. The first woman, aged 36, and the second woman, aged 26, on her second postpartum day, both developed similar types of symptoms like periorbital swelling, itching, and difficulty breathing after taking oral ketorolac. The second woman had a history of allergic rashes. They received immediate treatment with epinephrine, oxygen therapy, intravenous fluids, and other medications. They showed a rapid improvement and were discharged after observation. Clinical discussion Anaphylactic reactions to ketorolac, a commonly used pain management drug, have been reported. Symptoms include swelling, difficulty breathing, and hypotension. Treatment involves medications like epinephrine, hydrocortisone, and pheniramine. A detailed medical history, laboratory investigations, appropriate medication, oxygen therapy, and follow-up care are important in managing anaphylactic reactions, which can be life-threatening. Conclusion Although rare, ketorolac can cause anaphylactic reactions in patients with or without a history of drug allergy. Immediate recognition and management are essential, along with a detailed medical history and follow-up care.
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Affiliation(s)
- Tek N. Yogi
- Department of General Practice and Emergency Medicine
| | - Amrit Bhusal
- Department of Surgery, B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Rijan Kafle
- Department of General Practice and Emergency Medicine
| | - Sujal Labh
- Department of General Practice and Emergency Medicine
| | - Sagar Pokhrel
- Department of General Practice and Emergency Medicine
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Céspedes JA, Fernández-Santamaría R, Ariza A, Bogas G, Doña I, Rondón C, Salas M, Labella M, Frecha C, Mayorga C, Torres MJ, Fernández TD. Diagnosis of immediate reactions to amoxicillin: Comparison of basophil activation markers CD63 and CD203c in a prospective study. Allergy 2023; 78:2745-2755. [PMID: 36478407 DOI: 10.1111/all.15610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 07/13/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Amoxicillin (AX) combined or not with clavulanic acid (CLV) is frequently involved in IgE-mediated reactions. Drug provocation test (DPT) is considered as the gold standard for diagnosis, although contraindicated in high-risk patients. Basophil activation test (BAT) can help diagnose immediate reactions to beta-lactams, although controversy exists regarding the best activation marker. We have performed a real-life study in a prospective cohort to analyze the real value of BAT as diagnostic tool and the best activation marker, CD63 and CD203c, for the evaluation of immediate reactions to these drugs. METHODS We prospectively evaluated patients with a clinical suspicion of immediate reactions after AX or AX-CLV administration during a 6-year period. The allergological work-up was done following the EAACI recommendations. BAT was performed in all patients using CD63 and CD203c as activation markers. RESULTS In AX-allergic patients, both activation markers, CD63 and CD203c, showed similar SE values (48.6% and 46.7%, respectively); however, specificity was of 81.1% and 94.6%, respectively, with CD203c showing good positive predictive value and like-hood ratio. In CLV-allergic patients, CD203c showed higher SE (50%) than CD63 (42.9%), maintaining the same value of SP (80%). Combining the results of both markers can slightly increase the sensitivity (51.4% for AX and 54.8% for CLV), although decreasing the specificity (79.7% and 73%, respectively). Interestingly, all patients with an anaphylactic shock showed a positive BAT to CLV using CD203c. CONCLUSIONS BAT using CD203c showed a good confirmatory power, especially for AX allergy. Placing BAT as a first step in the diagnostic procedure can help reduce the need of performing a complete allergological work-up in 46.6% of patients, diminishing the risk of reinducing allergic reactions.
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Affiliation(s)
- Jose A Céspedes
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Rubén Fernández-Santamaría
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
| | - Adriana Ariza
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
| | - Gador Bogas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Inmaculada Doña
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Carmen Rondón
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - María Salas
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Marina Labella
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - Cecilia Frecha
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
| | - María J Torres
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga-ARADyAL, Málaga, Spain
- Departamento de Medicina y Dermatología, Universidad de Málaga, Málaga, Spain
| | - Tahia D Fernández
- Allergy Research Group, IBIMA Plataforma BIONAND, Málaga, Spain
- RICORS Red De Enfermedades Inflamatorias (REI), Madrid, Spain
- RETICS Asma, Reacciones Adversas y Alérgicas (ARADYAL), Madrid, Spain
- Departamento de Biología Celular, Genética y Fisiología, Universidad de Málaga, Málaga, Spain
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Fransson S, Boel JB, Holm A, Kahlhofen N, Hjortlund J, Mosbech HF, Poulsen LK, Reventlow S, Garvey LH. Inconsistencies in penicillin allergy labels in hospital and primary care after allergy investigation. Clin Exp Allergy 2023; 53:969-973. [PMID: 37246612 DOI: 10.1111/cea.14347] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Sara Fransson
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Anne Holm
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Kahlhofen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Janni Hjortlund
- Laegerne Hansen, Møller, Pelvig and Hjortlund, Valby, Denmark
| | - Holger F Mosbech
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Susanne Reventlow
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Kwan MSK, Tan SL, Keowmani T, Goh SL, Voo JYH, Tan HS, Zakaria MRB, Raman S, Ho JCK, Zainullah Faidin DKB, Madi NB, Itim KB. Drug allergy knowledge, attitude, and practice: A survey among doctors and pharmacists in public health facilities of Sabah, Malaysia. Asia Pac Allergy 2023; 13:121-126. [PMID: 37744958 PMCID: PMC10516309 DOI: 10.5415/apallergy.0000000000000115] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/10/2023] [Indexed: 09/26/2023] Open
Abstract
Background Given the deficits in allergists and testing capacity, the diagnosis of drug allergy is largely dependent on the clinician's and pharmacist's judgment. The ability to recognize drug allergies and respond appropriately is crucial to patient safety. Currently, there is a void in the evidence that limits the ability to recommend comprehensive and swift improvements on this front. Objective This study thus aimed to evaluate the knowledge, attitude, and practice toward drug allergy among doctors and pharmacists working in public healthcare facilities in Sabah, Malaysia. Methods This cross-sectional study was conducted in 24 hospitals and 11 clinics in Sabah. A validated Drug Allergy Knowledge, Attitude, and Practice Questionnaire was adapted from a published study and developed on an online survey platform. The questionnaire was distributed to all listed eligible respondents via email and personal messenger service. Results A total of 549 doctors and pharmacists responded, with an overall response rate of 18.2%. The total mean knowledge, attitude, and practice scores were 8.3 (SD, 1.98), 18.9 (SD, 2.55), and 17.3 (SD, 4.4), respectively. It was found that pharmacists performed significantly poorer than both medical officers (mean score difference = -0.5; P = 0.006) and specialists (mean score difference = -0.9; P = 0.020) in the knowledge domain. As the time in service doubles, the knowledge score increases significantly by 0.3 (P = 0.015). Conclusion Knowledge, attitude, and practice on drug allergy among doctors and pharmacists in Sabah were poor. It is thus timely for advanced educational programs on drug allergy to be formalized and implemented.
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Affiliation(s)
| | - Sze Ling Tan
- Pharmacy Department, Hospital Queen Elizabeth II, Sabah, Malaysia
| | - Thamron Keowmani
- Pharmacy Department, Hospital Wanita Dan Kanak-Kanak Sabah, Sabah, Malaysia
| | - Sor Leng Goh
- Pharmacy Department, Hospital Wanita Dan Kanak-Kanak Sabah, Sabah, Malaysia
| | | | - Hoo Seng Tan
- Pharmacy Department, Hospital Duchess of Kent, Sabah, Malaysia
| | | | - Sivaraj Raman
- Institute for Health Systems Research, National Institutes of Health, Selangor, Malaysia
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Jhan JY, Wang WE, Chu SC, Cheng CH, Chang CH. Case Report: Ribociclib-induced phototoxicity presented as dyschromia with subsequent bullae formation. Front Oncol 2023; 13:1184738. [PMID: 37692847 PMCID: PMC10484504 DOI: 10.3389/fonc.2023.1184738] [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: 03/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Ribociclib, a cyclin-dependent kinase 4/6 inhibitor, is a novel targeted therapy for advanced-stage breast cancer. Although ribociclib-induced cutaneous side effects have been previously noted, they have not been well documented. Herein, we present a case of ribociclib-induced phototoxicity, which manifested as dyschromia over sun-exposed forearms and neck initially and as bullae formation subsequently. A 71-year-old woman with metastatic breast cancer developed dyschromia after daily treatment with ribociclib (600 mg) for 7 months. Skin biopsy of the pigmented lesion revealed interface dermatitis with melanin incontinence and dyskeratotic cells and ballooning keratinocytes with loss of melanocytes in the basal layer. Further, clefting at the basal layer of epidermis was noted in a more hyperpigmented field. Fontana-Masson staining revealed melanophages in the dermis. Human Melanoma Black-45 staining revealed decreased melanocyte numbers in the epidermis above the cleft. Immunohistochemical analyses revealed activated CD1a+ epidermal Langerhans cells and infiltrating CD4+ and CD8+ T cells in the epidermis and dermis, thereby indicating type IV hypersensitivity that was associated with damage to keratinocytes and melanocytes. To prevent progression of bullous dermatitis, we advised the patient to discontinue ribociclib and prescribed oral and topical prednisolone. Due to the risk of phototoxicity, we educated the patient on sun-protection strategies. The patient's skin lesions subsided during the 2 months of treatment. Phototoxicity with dyschromia is a rare but significant ribociclib-induced cutaneous side effect. Early diagnosis, rapid ribociclib withdrawal, protection from sunlight, and prompt treatment are critical for preventing subsequent severe bullous dermatosis.
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Affiliation(s)
- Jyun-Yan Jhan
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Wei-En Wang
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Sung-Chao Chu
- Department of Hematology-Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chiu-Hsuan Cheng
- Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Chung-Hsing Chang
- Skin Institute, Department of Dermatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Taipei, Taiwan
- Institute of Medical Sciences, College of Medicine, Tzu Chi University, Hualien, Taiwan
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Ribak Y, Rubin L, Talmon A, Dranitzki Z, Shamriz O, Hershkowitz I, Tal Y, Hershko AY. Administration of BNT162b2 mRNA COVID-19 vaccine to subjects with various allergic backgrounds. Front Immunol 2023; 14:1172896. [PMID: 37654487 PMCID: PMC10465362 DOI: 10.3389/fimmu.2023.1172896] [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: 02/23/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Background The mRNA-based COVID-19 vaccine was introduced to the general public in December 2020. Shortly thereafter, safety concerns were raised due to the reporting of allergic reactions. Allergy-related disorders were suspected to be significant risk factors and the excipient polyethylene glycol was suggested to be a robust allergen. Methods This is a retrospective study analysis. Subjects with putative risk factors for severe allergic reactions to the Pfizer-BioNTech BNT162b2 vaccine were referred for vaccination under observation at the Unit of Allergy and Clinical Immunology. Data was collected for each subject, including demographic details, medical history and previous reactions to any allergen. When appropriate, skin tests were done prior to vaccination. Results A total of 346 subjects received 623 vaccine doses under observation. The study included patients with various allergy-related disorders (n=290) and those with allergy to a previous COVID-19 vaccine dose (n=56). Both groups showed female predominance (78% and 88%, p=NS). Patients without reactions to previous doses reported more drug allergy (80% vs. 39%, p<0.001) and previous anaphylaxis (64% vs. 14%, p<0.001). There was no difference in sensitivity to other allergens, including polyethylene glycol. Under observation, mild allergic reactions were noted in 13 individuals characterized by female gender (100%), a history of anaphylaxis (69%) and drug allergy (62%). In 7 subjects, allergy was treated with antihistamines while others recovered spontaneously. Conclusion Our study demonstrates that vaccination under specialist-supervision is a powerful tool for reducing over-diagnosis of systemic reactions and for rapid and reliable collection of vaccine safety data.
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Shi L, Zhao J, Zeng L, Wang L, Zhang G. Dermatosis Neglecta Based on Exanthematous Drug Eruption Following Head Trauma: A Case Report and Literature Review. Clin Cosmet Investig Dermatol 2023; 16:2083-2088. [PMID: 37575148 PMCID: PMC10417696 DOI: 10.2147/ccid.s419092] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023]
Abstract
Dermatosis neglecta (DN) is a rare psychogenic dermatosis. To our knowledge, this is the first reported case of DN based on exanthematous drug eruption. We report a 68-year-old Chinese male patient who presented with thick, yellowish-brown crusting on his face and scalp and scaly skin for 6 days. Dermoscopy revealed diffusely distributed yellow-green serescrust-like plaques with different sizes and uneven thickness on a red background, and some demonstrated dot or globular hemorrhages. We considered DN and exanthematous drug eruptions based on the combination of the clinical medication and the history before the rash.
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Affiliation(s)
- Liping Shi
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shijiazhuang, People’s Republic of China
| | - Jiaqing Zhao
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shijiazhuang, People’s Republic of China
| | - Linxi Zeng
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shijiazhuang, People’s Republic of China
| | - Lihong Wang
- Department of Dermatology, Luancheng People’s Hospital, Shijiazhuang, People’s Republic of China
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- Candidate Branch of National Clinical Research Center for Skin Diseases, Shijiazhuang, People’s Republic of China
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Al-Obaydi S, Popadiuk CA, Al-Shaikhly T. Proton pump inhibitors and the risk of acquiring a penicillin allergy label. Intern Med J 2023; 53:1481-1484. [PMID: 37548300 PMCID: PMC10529584 DOI: 10.1111/imj.16197] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/04/2023] [Indexed: 08/08/2023]
Abstract
The negative consequences of having a penicillin allergy label are well established. Penicillin allergy de-labelling improves healthcare outcomes; however, less attention is paid to modifying risk factors leading to penicillin allergy development. In this propensity score-matched retrospective cohort study, we used a de-identified population-based database (TriNetX Research Network) and examined the 30-day risk of acquiring a penicillin allergy label in patients using proton pump inhibitors (PPIs). We demonstrated a higher risk of acquiring a penicillin allergy label among PPI users compared to controls.
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Affiliation(s)
- Sarah Al-Obaydi
- Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, U.S.A
| | - Catherine A. Popadiuk
- Division of Pulmonary, Allergy & Critical Care, Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, U.S.A
| | - Taha Al-Shaikhly
- Division of Pulmonary, Allergy & Critical Care, Department of Medicine, Penn State College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, U.S.A
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Lendal V, Fransson S, Mosbech H, Boel JB, Kahlhofen N, Blom LH, Poulsen LK, Garvey LH. Specific IgE to penicillin minor determinants in patients with suspected penicillin allergy. Clin Exp Allergy 2023; 53:887-890. [PMID: 37246578 DOI: 10.1111/cea.14333] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Victor Lendal
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Sara Fransson
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Holger Mosbech
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Jonas Bredtoft Boel
- Department of Clinical Microbiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Natasha Kahlhofen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lars H Blom
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lars K Poulsen
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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41
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Jin Y, Zheng M, He S, Chen M, Cao C. Safety of Inactivated SARS-CoV-2 Vaccines Among Adults with Experience of Allergies to Food or Medicines. Int J Gen Med 2023; 16:3105-3113. [PMID: 37496598 PMCID: PMC10368019 DOI: 10.2147/ijgm.s422337] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/14/2023] [Indexed: 07/28/2023] Open
Abstract
The global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), commonly known as COVID-19, poses significant risk to human health worldwide. The primary strategy for controlling the disease is through vaccination. However, there is an urgent need to establish confidence in the safety of global vaccination efforts, particularly among populations with allergies, as evidence on the adverse effects of SARS-CoV-2 vaccines in this group remains limited. To address this gap, our study aimed to evaluate the safety of inactivated SARS-CoV-2 vaccines in individuals with food and/or drug allergies. The study enrolled a total of 150 participants, who were subjected to a series of questionnaires to evaluate local and systemic reactions within 7 days after each dose. The results revealed that the most prevalent adverse reactions were pain at the injection site (30%) and fatigue (16%) following the initial vaccination. Notably, the incidence of both local and systemic adverse reactions decreased after the second vaccination, which was unexpected. The food allergy and drug allergy subgroups exhibited a similar phenomenon. Furthermore, the incidence of adverse events observed in this study was consistent with the range reported in Phase III clinical trials of inactivated SARS-CoV-2 vaccines. Our findings suggest that individuals with pre-existing food and/or drug allergies have a favorable safety profile when receiving inactivated SARS-CoV-2 vaccination.
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Affiliation(s)
- Yan Jin
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Municipal Hospital Affiliated to Taizhou University, Taizhou, People’s Republic of China
| | - Mengmeng Zheng
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Shiyi He
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Meiping Chen
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, Ningbo, People’s Republic of China
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Trubiano JA, Vogrin S, Mitri E, Hall R, Copaescu A, Waldron J, De Luca J, Rose M, Mackay G, Lambros B, Douglas AP, Holmes NE, Chua KYL. The Who, What, When, and Where of Inpatient Direct Oral Penicillin Challenge-Implications for Health Services Implementation. Clin Infect Dis 2023; 77:19-22. [PMID: 36929823 DOI: 10.1093/cid/ciad156] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 01/03/2023] [Revised: 02/13/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Abstract
Inpatient direct oral challenge programs are increasingly deployed as part of antimicrobial stewardship initiatives to reduce the burden and impacts of penicillin allergy labels on antibiotic prescribing. Using data from a prospective, multicenter cohort inpatient penicillin allergy program, we identify the key targets for delabeling to aid health service implementation.
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Affiliation(s)
- Jason Anthony Trubiano
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sara Vogrin
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Elise Mitri
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Pharmacy, Austin Health, Heidelberg, Victoria, Australia
| | - Rebecca Hall
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Ana Copaescu
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Medicine, Division of Allergy and Clinical Immunology, McGill University Health Center, Montreal, Quebec, Canada
| | - Jamie Waldron
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Joseph De Luca
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
| | - Morgan Rose
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Geoff Mackay
- Albury Wodonga Health, Albury, New South Wales, Australia
| | - Belinda Lambros
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
| | - Abby P Douglas
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, VIC, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health and The University of Melbourne, Heidelberg, Victoria, Australia
| | - Kyra Y L Chua
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, Victoria, Australia
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Elzagallaai AA, Rieder MJ. Novel insights into molecular and cellular aspects of delayed drug hypersensitivity reactions. Expert Rev Clin Pharmacol 2023; 16:1187-1199. [PMID: 38018416 DOI: 10.1080/17512433.2023.2289543] [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: 09/18/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Delayed drug hypersensitivity reactions (DDHRs) represent a major health problem. They are unpredictable and can cause life-long disability or even death. The pathophysiology of DDHRs is complicated, multifactorial, and not well understood mainly due to the lack of validated animal models or in vitro systems. The role of the immune system is well demonstrated but its exact pathophysiology still a matter of debate. AREA COVERED This review summarizes the current understanding of DDHRs pathophysiology and abridges the available new evidence supporting each hypothesis. A comprehensive literature search for relevant publications was performed using PubMed, Google Scholar, and Medline databases with no date restrictions and focusing on the most recent 10 years. EXPERT OPINION Although multiple milestones have been achieved in our understanding of DDHRs pathophysiology as a result of the development of useful experimental models, many questions are yet to be fully answered. A deeper understanding of the mechanistic basis of DDHRs would not only facilitate the development of robust and reliable diagnostic assays for diagnosis, but would also inform therapy by providing specific target(s) for immunomodulation and potentially permit pre-therapeutic risk assessment to pursue the common goal of safe and effective drug therapy.
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Affiliation(s)
- Abdelbaset A Elzagallaai
- Department of Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Michael J Rieder
- Department of Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
- Department of Paediatrics and Physiology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Jarkvist J, Gülen T. Diagnostic Evaluation of Hypersensitivity Reactions to Antibiotics in a Large Cohort of Mastocytosis Patients. Diagnostics (Basel) 2023; 13:2241. [PMID: 37443635 DOI: 10.3390/diagnostics13132241] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Anaphylactic reactions are a well-known feature of mastocytosis, particularly in relation to hymenoptera venom stings. Although data on the frequency of drug hypersensitivity reactions is limited in mastocytosis, it is hypothesized that these patients may be predisposed to hypersensitivity reactions to certain drugs, including antibiotics. Nevertheless, this issue has not been systematically investigated. Thus, we investigate the prevalence and clinical features of hypersensitivity reactions to antibiotics (HRA) in mastocytosis. METHODS A 15-year retrospective study was conducted among 239 (≥18 years old) consecutive mastocytosis patients who were investigated in our center. All patients underwent a thorough allergy work-up, where self-reported reactions were individually evaluated by an allergist. RESULTS Overall, 34 patients (14.2%) were deemed to have HRA. Most patients reacted with cutaneous symptoms (74%), and anaphylaxis was rare, confirmed only in two of 34 patients (0.8%). Beta-lactams were the most common elicitors (63%). There were no differences in age, gender, atopic status and tryptase levels between mastocytosis patients with and without antibiotic hypersensitivity. CONCLUSIONS The present study indicates a similar prevalence of HRA in mastocytosis compared to those of the general population. Moreover, antibiotics appear to be rare elicitors of anaphylaxis in these patients. Hence, our results suggest that mastocytosis patients without a history of HRA may be treated with these drugs without special precautions.
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Affiliation(s)
- Jesper Jarkvist
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, 141 52 Stockholm, Sweden
- Mastocytosis Center Karolinska, Karolinska University Hospital Huddinge, 141 86 Stockholm, Sweden
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Christopher DJ, Natania A, Daniel J, Balamugesh T, Isaac B, Krishna MT. Prevalence of drug allergy labels in a tertiary pulmonary service in South India. Clin Exp Allergy 2023. [PMID: 37365847 DOI: 10.1111/cea.14365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Affiliation(s)
| | - Arin Natania
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Barney Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ameer MA, Mushtaq J, Chaudhry H, Patel N, Khan SI. Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema: A Case Report With a Review of Management Options. Cureus 2023; 15:e40320. [PMID: 37448396 PMCID: PMC10337988 DOI: 10.7759/cureus.40320] [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] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Angiotensin-converting enzyme inhibitors (ACEIs) are widely used for heart failure, renal failure, diabetic nephropathy, stroke, arterial hypertension, and a number of other cardiovascular or related conditions. ACEI-induced angioedema is a rare entity but can result in life-threatening emergencies. It mainly occurs in patients starting on ACEI as an antihypertensive. We present a case of lisinopril-induced angioedema in an African American patient managed in the emergency department. After appropriate evaluation, the patient was declared safe to be observed in the emergency department. Intubation was not performed. Early identification of angioedema is paramount, and emergency physicians should maintain airways or intubate such patients if indicated. There should be a high level of suspicion of angioedema in patients taking ACEIs if they present with symptoms of respiratory compromise.
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Affiliation(s)
| | - Javaria Mushtaq
- Cell Biology and Neuroscience, Rowan University, Stratford, USA
| | - Haroon Chaudhry
- Internal Medicine, Suburban Community Hospital, East Norriton, USA
| | - Nimi Patel
- Internal Medicine, Suburban Community Hospital, East Norriton, USA
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Arcolaci A, Scarmozzino R, Zanoni G. A practical guide to address reactions to vaccines in children. Pediatr Allergy Immunol 2023; 34:e13967. [PMID: 37366202 DOI: 10.1111/pai.13967] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/04/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
Currently available vaccines are safe, but, potentially, any vaccine can cause an allergic reaction and, albeit very rare, anaphylaxis can occur. Although its rarity, the precise diagnostic management of a suspected anaphylaxis postvaccination is of paramount importance due to the risk of a potentially serious reaction after re-exposure, while a misdiagnosis might lead to an increase in the number of children that interrupt vaccinations resulting in an unjustifiably individual and collective risk of loss of protection against immune preventable diseases. In the light that most cases of suspected allergy to a vaccine are not effectively confirmed in up to 85% of the cases referred for an allergy evaluation, patients can continue the vaccination schedule with the same formulation and tolerance of the booster doses. The patient assessment has to be done by an expert in the vaccine field, usually an allergist or an immunologist depending on the country, to select subjects at risk of allergic reactions and to perform the correct procedures for vaccine hypersensitivity diagnosis and management, in order to guarantee safe immunization practices. The aim of this review is to provide a practical guidance for the safe management of allergic children undergoing immunization procedures. The guide is referred both to the evaluation of children who have previously experienced a suspected allergic reaction to a specific vaccine and their management in case of further booster doses, and to children allergic to a component of the vaccine to be administered.
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Affiliation(s)
- Alessandra Arcolaci
- Immunology Unit, Borgo Roma University Hospital, Verona, Italy
- Green Channel Consultancy Clinic for Vaccine Adverse Event Prevention and Surveillance, Verona, Italy
| | - Rocco Scarmozzino
- Immunology Unit, Borgo Roma University Hospital, Verona, Italy
- Green Channel Consultancy Clinic for Vaccine Adverse Event Prevention and Surveillance, Verona, Italy
| | - Giovanna Zanoni
- Immunology Unit, Borgo Roma University Hospital, Verona, Italy
- Green Channel Consultancy Clinic for Vaccine Adverse Event Prevention and Surveillance, Verona, Italy
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48
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Spataro F, Carlucci P, Loverre T, Macchia L, Di Bona D. Hypersensitivity reaction during enzyme replacement therapy in lysosomal storage disorders. A systematic review of desensitization strategies. Pediatr Allergy Immunol 2023; 34:e13981. [PMID: 37366214 DOI: 10.1111/pai.13981] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
Lysosomal storage diseases (LSDs) are rare genetic metabolic disorders that cause the accumulation of glycosaminoglycans in lysosomes due to enzyme deficiency or reduced function. Enzyme replacement therapy (ERT) represents the gold standard treatment, but hypersensitivity reaction can occur resulting in treatment discontinuation. Thus, desensitization procedures for different culprit recombinant enzymes can be performed to restore ERT. We searched desensitization procedures performed in LSDs and focused on skin test results, protocols and premedication performed, and breakthrough reactions occurred during infusions. Fifty-two patients have been subjected to desensitization procedures successfully. Skin tests, with the culprit recombinant enzyme, deemed positive in 29 cases, doubtful in two cases, and not performed in four patients. Moreover, 29 of the 52 desensitization protocols used at the first infusion were breakthrough reaction free. Different desensitization strategies have proved safe and effective in restoring ERT in patients with previous hypersensitivity reactions. Most of these events seem to be Type I hypersensitivity reactions (IgE-mediated). Standardized in vivo and in vitro testing is necessary to better estimate the risk of the procedure and find the safest individualized desensitization protocol.
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Affiliation(s)
- Federico Spataro
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Palma Carlucci
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Teresa Loverre
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Luigi Macchia
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
| | - Danilo Di Bona
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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Madrigal-Burgaleta R, Castells M. Editorial: Diagnosis and management of allergy to chemotherapy and biologics. Front Allergy 2023; 4:1205345. [PMID: 37250973 PMCID: PMC10210475 DOI: 10.3389/falgy.2023.1205345] [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: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Affiliation(s)
- Ricardo Madrigal-Burgaleta
- Allergy & Severe Asthma Service, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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Saretta F, Tomei L, Mori F, Mayorga C. In vitro diagnostic testing for drug allergy in children. Pediatr Allergy Immunol 2023; 34:e13955. [PMID: 37102390 DOI: 10.1111/pai.13955] [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: 02/28/2023] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
Diagnosing Drug Hypersensitivity Reactions (DHRs) could be a complicated process especially in children, since allergic-like manifestation at this age is more often the expression of concomitant infections rather than a actual DHRs. In vivo tests are usually suggested as a first step; however, prick and intradermal tests could be painful and have shown different sensitivity and specificity among published studies. In some cases, in vivo tests such as Drug Provocation test (DPT) could be even contraindicated. Therefore, the need for in vitro testing is compelling, to add useful information along the diagnostic pathway and to limit the need of DPT. In this review, we analyze the different types of in vitro tests, focusing on those used more widely such as specific IgE and on those that are still for research settings, such as basophil activation test and lymphocyte transformation test, but that have shown some useful diagnostic potential.
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Affiliation(s)
- Francesca Saretta
- Pediatric Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Leonardo Tomei
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Mori
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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