Outcomes and safety of drug provocation tests.

Drug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs.

Nonsteroidal anti-inflammatory drugs are major causes of drug-induced anaphylaxis.

BACKGROUND: Drugs are responsible for 40% to 60% of anaphylactic reactions treated in the emergency department. A global research agenda to address uncertainties in anaphylaxis includes studies that identify factors associated with morbidity and mortality. OBJECTIVE: The present study investigated drug-induced anaphylaxis, etiologies, aggravating factors, and treatment. METHODS: A total of 806 patients with adverse drug reactions were screened, and those who had a clinical diagnosis of anaphylaxis were included in the study. Clinical and demographic characteristics of anaphylaxis were described, including etiologies, pathophysiologic mechanisms involved in the reactions, and a personal history of atopy and asthma. Factors associated with disease severity also were identified. RESULTS: Anaphylaxis was diagnosed in 117 patients (14.5%). The etiologies were defined in 76% of the cases, nonsteroidal anti-inflammatory drugs being the most frequent. Seventy-eight patients (66.7%) reported a previous reaction to the drug involved in the current reaction or to a drug from the same class and/or group. Epinephrine was used to treat 34.2% of patients who presented with anaphylaxis, and 40.8% of those with anaphylactic reactions with cardiovascular involvement. IgE-mediated reactions were associated with greater severity, manifested by the rates of cardiovascular dysfunction, hospitalization, and use of epinephrine. CONCLUSIONS: The prevalence of anaphylaxis is high in patients who seek medical assistance for drug reactions, but its diagnosis is missed in emergency services, and adrenaline is underused. Drugs were prescribed to many patients despite a history of previous reaction. Nonsteroidal anti-inflammatory drugs were implicated in most cases of anaphylaxis induced by drugs, and IgE-mediated reactions were less frequent but more severe.

Recomendações para o diagnóstico de alergia ao látex / Recommendations for the diagnosis of latex allergy

Objetivo: Fornecer uma atualização das condutas atuais baseadas em evidências, no que diz respeito à abordagem da alergia ao látex, de forma prática e objetiva. Fontes de dados: Foram utilizados os bancos de dados: Pubmed e Lilacs; artigos de revisão, manuais de conduta prática e atualizações no tema. Síntese de dados: Este artigo enfoca os parâmetros práticos da conduta em pacientes com história de alergia ao látex. Conclusões: A alergia ao látex constitui um grande desafio na prática diária do médico alergista, especialmente no que se refere ao diagnóstico diferencial das reações de hipersensibilidade aos medicamentos. Desta forma, é importante abordar este tópico de forma clara e prática, a fim de auxiliar o médico especialista a conduzir de forma correta a investigação dos casos suspeitos

Objective: This document was developed as an updated practice parameter to improve the care of patients by providing the practicing physician with an evidence-based approach in the management of latex allergy. Sources: Medline and Lilacs databases; review papers, practice parameters and updates in beta lactam allergy management. Data synthesis: This is a practice parameter review on latex allergy management. Conclusions: Latex allergy results in major health problems for allergists, especially regarding the differential diagnosis in drug hypersensitivity. Knowledge of the latex allergic patient management is very important in the investigation of suspected subjects.