Eosinophilia in Amoxicillin-Induced Rash in Infectious Mononucleosis.

A link between amoxicillin-induced rash in infectious mononucleosis and allergy has been previously reported. However, the pathophysiological cause and aspects are unclear. Additionally, the complex immunological interaction between the host and Epstein-Barr virus needs to be studied. This article reports a case of amoxicillin-induced rash in infectious mononucleosis resulting in an exuberant rash, facial edema, and marked eosinophilia, which prompted additional workup. Both the eosinophilia and the rash brought to light a possible association with a persistent delayed-type hypersensitivity. Further scientific discussion and investigation can identify predictive indicators that can portend clinical outcome.

An experimental biological test to diagnose hypersensitivity reactions to carboplatin: new horizons for an old problem.

Carboplatin, a second-generation platinum compound, is a chemotherapeutic drug effective in many types of cancers. Its use is limited by the development of systemic allergic reactions in up to 30% of the cancer patients. Therefore, it is very important to make a correct diagnosis of true carboplatin allergy, for the crucial clinical implications. In this regard, no biological test is actually available to detect specific immunoglobulin E in the sera of patients allergic to carboplatin. We evaluated a new experimental biological test in patients with suspected immunoglobulin E-mediated reactions to carboplatin. Three patients with suspected hypersensitivity reactions to carboplatin underwent skin tests with an undiluted aliquot (10 mg/ml) of carboplatin preparation planned for infusion. Total serum immunoglobulin E and specific immunoglobulin E to the two platinum salts carboplatin and cisplatin were determined with the ImmunoCAP system (Phadia AB, Uppsala, Sweden). We detected specific immunoglobulin E to carboplatin in all three patients, whereas specific immunoglobulin E to cisplatin was observed in one patient. The positivity of specific immunoglobulin E against carboplatin in these three patients is a new and encouraging observation for the development of a new important instrument that can help clinicians in their therapeutic decisions, after a hypersensitivity reaction to a platinum salt.

Type B adverse drug reactions reported by an immunoallergology department.

OBJECTIVE: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). METHODS: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. RESULTS: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). CONCLUSIONS: Reported ADR to NPC by the Drug Alert Unit were mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategies to prevent the clinical and economic consequences of ADR.

Type B adverse drug reactions reported by an immunoallergology department

Objective: Characterization of the adverse drug reactions (ADR) reported by the immunoallergology department (IAD), Centro Hospitalar de São João (Porto), to the Northern Pharmacovigilance Centre (NPC). Methods: An observational, descriptive and retrospective study was conducted, based in a spontaneous report system. Participants were all the patients from the IAD, with suspected ADR, reported to NPC by specialists after the study was completed. Results: Studied population had a median age of 41 years, with the predominance of the female gender (73.2%). Allergic rhinitis and asthma were the most frequent comorbidities. All studied ADR were type B, 89.6% were serious, 86.4% unexpected and 2.6% associated with drugs that presented less than 2 years in the market. The most represented drug classes were the non-steroidal anti-inflammatory drugs (NSAIDs) (52.6%) and antibiotics (25.2%). Skin symptoms represented 61.2% of the reported complaints. About 52.9% of these ADR occurred in less than one hour after intake. The most frequent ADR treatment at the time of the reaction was drug interruption (86.2%), followed by the prescription of anti-histamines (42.2%). Conclusions: Reported ADR to NPC by the Drug Alert Unitwere mainly serious, unexpected, associated with NSAIDs and antibiotics and related with marketing authorization medicines older than two years. These results could be very useful to develop strategiesto prevent the clinical and economic consequences of ADR (AU)

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[Chronic eosinophilic pneumonia]. / Pneumonia eosinofílica crónica.

Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare disorder of unknown cause, associated with intense and abnormal eosinophilic lung infiltration. Most cases occur in patients with prior history of atopy and asthma. It is characterized by subacute or chronic presentation, alveolar and blood eosinophilia and peripheral pulmonary infiltrates on chest imaging, which are sometimes migratory. All treated patients show good and rapid response to systemic corticosteroid therapy and favourable prognosis, however relapses are frequent after weaning or stopping treatment. By this reason, in about one-half of patients long-term systemic corticosteroid therapy is needed. We describe 2 clinical cases of ICEP which diagnosis was established after exclusion of any known cause of eosinophilic lung disease that represents different clinical, laboratorial and radiological patterns of this disease and are discussed in the context of the available data about ICEP and the differential diagnosis with other causes of pulmonary eosinophilia.

Treatment of severe dialysis reactions with the AN69-ST membrane: biocompatibility does matter.

Dialysis reactions with biocompatible membranes are rare, and complement activation has been suggested to be a culprit. We report here a case of an incident haemodialysis patient with asthma disease who experienced severe adverse reactions late into dialysis session, with different synthetic membranes (FX 80, Fresenius; Polyflux 17L, Gambro; FX 10, Fresenius; BLS 512, Bellco-Sorin). After replacing the dialyser by the surface-treated AN69 membrane (Nephral ST 500, Hospal), the dialysis sessions became uneventful. The case reinforces the need for biocompatible dialysers with high permeability and adsorptive capacity in susceptible patients experiencing severe dialysis reactions with synthetic membranes.

Successful desensitisation to ceftriaxone in a patient with doxycicline resistant Lyme disease

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