Drug Challenge Tests With General Anesthetics: Predictive Value of Skin Tests.

BACKGROUND: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests. METHODS: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018. RESULTS: We confirmed the high negative predictive value of the tests (96%-100%) in the case of propofol, rocuronium, and fentanyl. To our knowledge, this is the first study to describe drug challenge testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery. CONCLUSIONS: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient.

DRESS syndrome due to iodinated contrast media. A case report.

BACKGROUND: The most frequent non-immediate reactions described with iodinated contrast media (ICM) are mild to moderate, however, some cases of patients with severe non-immediate reactions, such as drug eruption with eosinophilia and systemic symptoms (DRESS) have been described. CASE PRESENTATION: An 84-year-old patient developed DRESS syndrome after administration of ICM ioversol. The patient fullfilled the RegiSCAR diagnostic criteria for DRESS (definite score = 6). He underwent intradermal skin testing (IDT) with the widest panel of ICM available at our center. IDT was positive with ioversol and iomeprol. A punch biopsy was performed on the positive IDT with the culprit drug (ioversol) and histopathology was compatible with a T-cell mediated mechanism. CONCLUSION: In this case, the IDT-positive biopsy was consistent with DRESS syndrome caused by T-lymphocyte activation, supporting the clinical diagnosis.

Drug challenge tests with general anesthetics: predictive value of skin tests

BACKGROUND: The study of perioperative drug reactions remains a major challenge for both diagnosis and therapy. The lack of a standard assessment of allergy to general anesthetics and of data establishing the true value of skin tests for most drugs used in induction and maintenance of anesthesia, as well as the lack of commercially available reagents for in vitro tests, renders the study of these reactions problematic. The aims of this study were to provide a diagnostic protocol for drug challenge testing with general anesthetics, to establish an etiological diagnosis that is as specific as possible, and to determine the predictive value of skin tests. METHODS: Twenty-nine patients with perioperative drug reactions were included in the study from November 2008 to December 2018. RESULTS: We confirmed the high negative predictive value of the tests (96%-100%) in the case of propofol, rocuronium, and fentanyl. To our knowledge, this is the first study to describe drug challenge testing with general anesthetics and, therefore, to establish the true negative predictive value of skin tests, which leads to a definitive diagnosis and safer surgery. CONCLUSIONS: After assessing risks and benefits and considering the importance of this group of drugs, we conclude that drug challenge testing with general anesthetics is necessary. We propose a protocol for perioperative drug reactions that enables us to make a highly accurate etiological diagnosis with minimum risk for the patient

ANTECEDENTES: La ausencia de estandarización del estudio de alergia a anestésicos generales y ausencia de verdaderos datos sobre el valor de las pruebas cutáneas en la mayoría de los fármacos empleados en anestesia general, así como la ausencia de reactivos disponibles comercialmente para poder realizar tests in vitro, continúa suponiendo un dilema para estudiar las reacciones perianestésicas. El objetivo de este estudio fue aportar un protocolo de pruebas de provocación con anestésicos generales para poder establecer un diagnóstico etiológico lo mas especifico posible, y determinar el valor predictivo de las pruebas cutáneas. MÉTODOS: Desde noviembre de 2008 a diciembre de 2018, fueron estudiados 29 pacientes con reacciones perioperatorias a medicamentos. RESULTADOS: Con este estudio, confirmamos el alto valor predictivo negativo (VPN) de las pruebas cutáneas (96-100%) en el caso del propofol, rocuronio y fentanilo. En nuestro conocimiento, este es el primer trabajo que describe pruebas de provocación con anestésicos generales, y en aportar el verdadero VPN de las pruebas cutáneas, lo que permite llegar a un diagnóstico más definitivo, y a una mayor seguridad en futuras cirugías. CONCLUSIONES: Valorando riesgos /beneficios y considerando la importancia de este grupo de medicamentos, concluimos que las pruebas de provocación controlada con anestésicos generales, son necesarias. Proponemos un protocolo diagnóstico de las reacciones perioperatorias por fármacos, que permita alcanzar un diagnóstico etiológico lo más certero posible, con el menor riesgo para el paciente

Delayed hypersensitivity reaction to lenalidomide: 2 different clinical patterns in the same patient

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Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant / Treatment of alteplase-induced orolingual angioedema by means of icatibant

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[Treatment of alteplase-induced orolingual angioedema by means of icatibant]. / Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

TITLE: Tratamiento del angioedema orolingual inducido por alteplasa mediante icatibant.

Fixed drug eruption due to ibuprofen.

Fixed drug eruptions due to ibuprofen have rarely been reported. Two days after treatment with ibuprofen, a 61-year-old woman developed erythema and pain affecting the tongue and oral mucosa. Two months later, the patient started ibuprofen and erythromycin for a catarrhal episode with reappearance of the same lesions in the oral mucosa 24 hours later. Furthermore, two new erythematosus-violaceous maculae developed. Topical challenge through an occluded patch test with ibuprofen 5% on the residual cutaneous lesion was successful. We present an unusual case of fixed drug eruption due to ibuprofen

Fixed drug eruption due to ibuprofen / Erupción fija medicamentosa por ibuprofeno

Fixed drug eruptions due to ibuprofen have rarely been described. Two days after treatment with ibuprofen, a 61-year-old woman developed erythema and pain affecting the tongue and oral mucosa. Two months later, the patient started ibuprofen and erythromycin for a catarrhal episode with reappearance of the same lesions in the oral mucosa 24 hours later. Furthermore, two new erythematosus-violaceous maculae developed. Topical challenge through an occluded patch test with ibuprofen 5 % on the residual cutaneous lesion was positive. We present an unusual case of fixed drug eruption due to ibuprofen

Rara vez se ha descrito algún caso de erupción fija medicamentosa debida al ibuprofeno. Una paciente de 61 años de edad, presentó eritema y dolor que afectaban a la lengua y la mucosa oral, dos días después de haber tomado ibuprofeno. Dos meses después, por un episodio catarral, volvió a tomar ibuprofeno además de eritromicina. Veinticuatro horas después reaparecieron las lesiones de la mucosa oral y además dos maculas eritemato-vesiculosas. La provocación tópica con prueba del parche con ibuprofeno al 5% sobre la lesión cutánea residual, resultó positiva, confirmando la causalidad de ese medicamento en la reacción atópica