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1.
Orv Hetil ; 153(15): 586-91, 2012 Apr 15.
Artigo em Húngaro | MEDLINE | ID: mdl-22472359

RESUMO

UNLABELLED: Allopurinol is an effective urate lowering drug, which is usually well-tolerated with no adverse effects in most cases, but about 2% of the treated patients develop a skin rash, and patients may experience severe allopurinol-induced hypersensitivity syndrome. AIMS: The aim of the authors was to summarize and present the clinical manifestations of allopurinol-induced hypersensitivity in patients treated at the Department of Dermatology and Allergology, University of Szeged in order to identify potential associations with this syndrome. METHODS: Retrospective review of all patients who were referred to the department with allopurinol-induced hypersensitivity syndrome in the last four years. RESULTS: During four years, 11 patients were treated with allopurinol-induced hypersensitivity syndrome. The average age was 70.3 years. Before the initiation of allopurinol therapy, 36% of patients had already suffered from various degrees of renal impairment, and 72% of them had been taking thiazide diuretics. Cutaneous manifestations were mainly generalized, erythematous, maculopapular exanthemas (9 patients, 82%), and two patients showed signs of erythema multiforme (18%). Asymptomatic hyperuricemia was the indication for allopurinol therapy in all patients. CONCLUSIONS: Allopurinol-induced hypersensitivity syndrome is a severe, life-threatening disease. Administration of allopurinol should be initiated with clear indications in appropriate dose. Old age, underlying renal impairment and concomitant thiazide diuretic intake should be considered as potential risk factors for developing hypersensitivity syndrome.


Assuntos
Alopurinol/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Supressores da Gota/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alopurinol/administração & dosagem , Dermatite Esfoliativa/induzido quimicamente , Toxidermias/etiologia , Hipersensibilidade a Drogas/patologia , Eritema Multiforme/induzido quimicamente , Exantema/induzido quimicamente , Feminino , Supressores da Gota/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Insuficiência Renal , Estudos Retrospectivos , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio/administração & dosagem , Inibidores de Simportadores de Cloreto de Sódio/efeitos adversos
2.
Allergy ; 66(3): 360-7, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20880148

RESUMO

BACKGROUND: Cytotoxic T cells seem to be the main effector cells in Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). However, recent data support a role of the innate immune system in the etiopathology of drug-induced cutaneous reactions. In this study, we analyzed the expression of α-defensins 1-3 in mononuclear cells from patients with SJS/TEN, drug-induced maculopapular exanthema (MPE), and healthy donors. METHODS: DEFA1A3 gene expression was analyzed by quantitative and end-point RT-PCR. Intracellular flow cytometry, immunofluorescence and immunohistochemistry were carried out to verify α-defensin 1-3 protein expression in mononuclear cells from peripheral blood and skin infiltrates. α-Defensin 1-3 concentration was evaluated in plasma and blister fluid samples by ELISA. RESULTS: We herein describe DEFA1A3 gene expression in peripheral blood mononuclear cells (PBMCs) from patients with drug-induced cutaneous diseases. Gene expression analysis unveiled transcription in CD4 and CD8 peripheral blood T cells. Protein expression was confirmed by intracellular flow cytometry in mononuclear cells from the patients, including monocytes, NK cells, and T cells from peripheral blood and blister fluid. Further analysis of protein content by flow cytometry revealed higher protein levels in CD56(+) CD3(+) lymphocytes from patients with SJS/TEN when compared to MPE and healthy donors. Immunohistological analysis was used to confirm expression in dermal infiltrates. α-Defensin levels were estimated by ELISA to be 3- to 175-fold higher in blister fluid when compared to simultaneously drawn plasma samples. CONCLUSION: Upregulation of innate immune molecules such as α-defensins 1-3 in T cells from patients with SJS/TEN may be involved in the etiopathology of these life-threatening diseases induced by medications.


Assuntos
Hipersensibilidade a Drogas/imunologia , Regulação da Expressão Gênica , Parapsoríase/imunologia , Síndrome de Stevens-Johnson/imunologia , Linfócitos T/imunologia , alfa-Defensinas/genética , alfa-Defensinas/imunologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Leucócitos Mononucleares/imunologia , Receptores de Lipopolissacarídeos/genética , Receptores de Lipopolissacarídeos/metabolismo , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Parapsoríase/patologia , Pele/imunologia , Síndrome de Stevens-Johnson/induzido quimicamente , Síndrome de Stevens-Johnson/patologia , Subpopulações de Linfócitos T/imunologia , Adulto Jovem
3.
CNS Spectr ; 11(5): 352-4, 2006 May.
Artigo em Inglês | MEDLINE | ID: mdl-16641839

RESUMO

Cutaneous rashes and eruptions can be caused by many medications, including carbamazepine. The presentation can be varied depending on severity. Cutaneous eruptions occur in 3% of individuals administered carbamazepine. Angioedema, a rare side effect of carbamazepine, involves vascular leakage in dermis and subcutis mediated by immunoglobulin E and/or bradykinins. Angioedema is more common in females and in the third decade of life. We report the case of a 27-year-old Indian woman who developed maculopapular rash and angioedema secondary to carbamazepine administration. The patient responded successfully to withdrawal of the drug and treatment with antihistamines. Due to the potentially life-threatening complications of this condition and the increasing use of anticonvulsants in the treatment of mood disorders, psychiatrists must be aware of the diagnosis and treatment of this condition.


Assuntos
Angioedema/induzido quimicamente , Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Toxidermias/etiologia , Parapsoríase/induzido quimicamente , Adulto , Anticonvulsivantes/uso terapêutico , Carbamazepina/uso terapêutico , Feminino , Humanos , Transtornos Psicóticos/tratamento farmacológico , Transtornos Puerperais/tratamento farmacológico , Índice de Gravidade de Doença
4.
J Fam Pract ; 7(3): 493-6, 1978 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-151125

RESUMO

Ampicillin is the most commonly prescribed antibiotic in the United States, and causes skin reactions in five to ten percent of patient populations. These reactions are considerably more frequent in patients with a viral illness, infectious mononucleosis, and lymphocytic leukemia. Skin reactions to ampicillin are usually of two types: a maculopapular rash in about two thirds of cases, and urticaria in about one third of cases. There is strong evidence that the maculopapular rash is a benign, nonallergic phenomenon. Patients with the maculopapular ampicillin rash are often incorrectly labeled as allergic to ampicillin/penicillin. Ampicillin can be continued and administered again in the future in these patients, and this kind of skin reaction resolves spontaneously in a few days without sequelae. Skin tests are neither required nor recommended to document the nonallergic basis of the maculopapular ampicillin rash.


Assuntos
Ampicilina/efeitos adversos , Parapsoríase/induzido quimicamente , Diagnóstico Diferencial , Toxidermias/diagnóstico , Toxidermias/etiologia , Toxidermias/terapia , Humanos , Lactente , Parapsoríase/diagnóstico , Parapsoríase/terapia
5.
Wiad Lek ; 43(7): 308-11, 1990 Apr 01.
Artigo em Polonês | MEDLINE | ID: mdl-2402917

RESUMO

A case is reported of rarely observed skin changes in a girl aged 5 years. The changes resembled those observed in acute parapsoriasis (p. lichenoides et varioliformis of Mucha-Habermann). The diagnosis was established after finding characteristic polymorphic lesions in the form of papulae, necrotizing vesicles, ulcerations, desquamation of certain papulae typical of p. guttata, long-term persistence of the lesions and good general condition of the child. The lesions were situated on the trunk, and in a lower degree on the face and extremities. Before the disease the girl hand contact with insecticides (Ovadofox) and detergents.


Assuntos
Parapsoríase/diagnóstico , Doença Aguda , Pré-Escolar , Dermatite de Contato/diagnóstico , Detergentes/efeitos adversos , Diagnóstico Diferencial , Feminino , Humanos , Inseticidas/efeitos adversos , Parapsoríase/induzido quimicamente , Vasculite Leucocitoclástica Cutânea/diagnóstico
6.
Epilepsy Res ; 106(1-2): 296-300, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23830818

RESUMO

The aims of this study were to clarify the possible associations of carbamazepine (CBZ)- and lamotrigine (LTG)-induced maculopapular exanthema (MPE) with the human leukocyte antigen (HLA) alleles in Chinese patients. A total of 249 subjects, including 40 patients with CBZ-induced MPE (CBZ-MPE), 43 patients with LTG-induced MPE (LTG-MPE), 52 CBZ-tolerant controls, 42 LTG-tolerant controls and 72 healthy controls, were included in this study. High-resolution HLA genotyping was performed by a specific kit. Differences in the allele frequencies among the groups were assessed. The allele frequencies of HLA-A*0201 and HLA-DRB1*1405 were significantly higher (P=0.033 and P=0.003, respectively), but those of HLA-B*5801 and HLA-DRB1*0301 (P=0.037 and P=0.024, respectively) were lower in the CBZ-MPE patients when compared with the CBZ-tolerant group. We also observed two significantly increased alleles of HLA-A*3001 and HLA-B*1302 (P=0.013 and P=0.013, respectively) and a decreased allele of HLA-A*3303 (P=0.048) in the LTG-MPE patients when compared with those in the LTG-tolerant group. Our results support the hypothesis that these HLA alleles contribute to the genetic susceptibility to CBZ/LTG-MPE and may be valuable as potential biomarkers for CBZ/LTG-MPE in Han Chinese.


Assuntos
Anticonvulsivantes/efeitos adversos , Carbamazepina/efeitos adversos , Toxidermias/epidemiologia , Antígenos HLA-B/genética , Parapsoríase/induzido quimicamente , Triazinas/efeitos adversos , Adulto , Alelos , Anticonvulsivantes/uso terapêutico , Povo Asiático , Biomarcadores , Carbamazepina/uso terapêutico , Estudos de Casos e Controles , China/epidemiologia , Toxidermias/genética , Feminino , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Antígeno HLA-B15/genética , Humanos , Lamotrigina , Masculino , Pessoa de Meia-Idade , Parapsoríase/epidemiologia , Parapsoríase/genética , Valor Preditivo dos Testes , Triazinas/uso terapêutico , Adulto Jovem
13.
Mult Scler ; 14(2): 259-61, 2008 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18337427

RESUMO

We describe a 41-year-old woman with multiple sclerosis, who presented erythematous maculopapular rash on the trunk and extremities after the second injection of interferon beta-1a. Histopathologic examination of the lesion revealed lymphocytic exocytosis and perivascular lymphocytic infiltrate in the dermis. Oral antihistamine and topical corticosteroid was started. After improvement of the lesions, the third injection was performed. However, the same reaction occurred. A prick test, which was performed 6 weeks after the eruption, also revealed positive reaction. Although injection-site reactions have been observed with interferon beta-1a, to our knowledge there have been no previous reports of interferon beta-1a-induced widespread cutaneous reaction.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Toxidermias/patologia , Interferon beta/efeitos adversos , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Parapsoríase/induzido quimicamente , Adjuvantes Imunológicos/administração & dosagem , Adulto , Biópsia , Feminino , Humanos , Injeções Intramusculares , Interferon beta-1a , Interferon beta/administração & dosagem , Parapsoríase/patologia
14.
Artigo em Inglês | MEDLINE | ID: mdl-17456917

RESUMO

Cutaneous involvement in renal disease is due to a host of factors ranging from metabolic disturbances to immunosuppressive drugs. Herein we report a series of six cases of renal failure with varied cutaneous manifestations ranging from infections to neoplasms due to prolonged immunosuppression. Our first case had cutaneous cryptococcosis where skin lesions gave a clue to the diagnosis of altered sensorium and underlying meningitis. The second case initially presented with florid warts and was treated successfully but later presented with an explosive recurrence of skin lesions due to malignant transformation. Our third case had basal cell carcinoma over the presternal region that was successfully treated with liquid nitrogen cryotherapy. Our fourth case had diabetic nephropathy that presented with septicemia and purpura fulminans. The last case had cutaneous manifestations of drug therapy because of heparin infusion. To conclude, cutaneous manifestations in patients with renal failure are varied and a high degree of suspicion is needed for early diagnosis and aggressive treatment to effectively combat mortality and morbidity.


Assuntos
Insuficiência Renal/complicações , Dermatopatias/etiologia , Injúria Renal Aguda/complicações , Adolescente , Adulto , Carcinoma Basocelular/etiologia , Condiloma Acuminado/etiologia , Criptococose/etiologia , Dermatomicoses/etiologia , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Neoplasias Cutâneas/etiologia
15.
South Med J ; 86(12): 1413-4, 1993 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-8272925

RESUMO

We have described a patient who had an extensive maculopapular pruritic rash after a single dose of warfarin. Although dermatologic reactions have been reported with this drug, the pathogenesis of these reactions remains unknown.


Assuntos
Parapsoríase/induzido quimicamente , Varfarina/efeitos adversos , Adulto , Toxidermias/etiologia , Feminino , Humanos
16.
Allergy ; 49(1): 57-9, 1994 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-8198241

RESUMO

Immune-mediated reactions to NSAIDs are unusual. We have observed two cases of maculopapular eruptions occurring 48-72 h after administration of diclofenac sodium. Patch tests performed with diclofenac were positive. The histopathologic findings resembled those of contact dermatitis with different degrees of dermal involvement. Clinical, allergologic, and histopathologic patterns strongly suggest a type IV mechanism of hypersensitivity. Patch tests play an important role in the assessment of possible immunologic mechanisms underlying cutaneous reactions to drugs.


Assuntos
Dermatite Alérgica de Contato/imunologia , Diclofenaco/efeitos adversos , Toxidermias/imunologia , Hipersensibilidade Tardia/imunologia , Parapsoríase/imunologia , Adulto , Diclofenaco/uso terapêutico , Feminino , Humanos , Hipersensibilidade Tardia/induzido quimicamente , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Testes do Emplastro
17.
J Allergy Clin Immunol ; 103(6): 1186-90, 1999 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-10359904

RESUMO

BACKGROUND: Maculopapular and urticarial rashes are nonimmediate manifestations common during aminopenicillin (AP) treatment, and the former often represent cell-mediated hypersensitivity. OBJECTIVES: We sought to determine the significance and incidence of skin test reactions to APs in adults reporting adverse reactions during therapy with these beta-lactams and, particularly, to evaluate the potential of patch tests, delayed-reading skin tests, and challenges in the diagnosis of nonimmediate reactions. METHODS: We used skin tests with penicilloylpolylysine, minor determinant mixture, benzylpenicillin, ampicillin, and amoxicillin, as well as patch tests with the last 3 drugs. We also performed in vitro assays for specific IgE and challenges with the suspect penicillin in subjects with nonimmediate reactions. RESULTS: Among the 144 patients reporting nonimmediate manifestations (mostly maculopapular rashes), delayed hypersensitivity was diagnosed in 62 on the basis of positive patch test and/or delayed intradermal test results and responses to challenges; negative reactions to challenges allowed us to reasonably exclude the possibility of allergy in 66 subjects, and the challenge confirmed that 1 patient had linear IgA bullous dermatosis. Definitive diagnoses could not be provided for the remaining 15 subjects, who had negative allergologic test results, because they did not consent to challenges. In 40 of 49 immediate reactors, a diagnosis of IgE-mediated hypersensitivity was made. CONCLUSIONS: Both patch and intradermal tests are useful in evaluating nonimmediate reactions to APs. Positive patch test and delayed intradermal responses together indicate delayed hypersensitivity. Intradermal testing appears to be more sensitive than patch testing, but the pattern of positive delayed intradermal test responses and negative patch test responses needs further investigation because of false-positive cases.


Assuntos
Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Tardia/induzido quimicamente , Penicilinas/efeitos adversos , Adolescente , Adulto , Idoso , Amoxicilina/efeitos adversos , Ampicilina/efeitos adversos , Feminino , Humanos , Hipersensibilidade Imediata/diagnóstico , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Penicilinas/imunologia , Teste de Radioalergoadsorção , Testes Cutâneos , Urticária/induzido quimicamente
18.
Artigo em Inglês | MEDLINE | ID: mdl-15315007

RESUMO

Plasma concentrations of interleukin-10 (IL-10) were examined in 126 patients with drug-induced cutaneous reactions: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), drug-induced urticaria (DU), hyperergic vasculitis (HV), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). Activity of the cytokine was measured using the immunoenzymatic ELISA method: a) in the acute stage of disease before treatment was administered, and b) after clearing of skin lesions, after treatment. In the acute stage of disease highly elevated mean concentrations of IL-10 in all 6 groups of patients were found (p<0.001) in comparison with the control. After clearing of clinical symptoms IL-10 concentrations were decreased highly significantly (ME, EM, DU, HV) or significantly (EMN, SJS/TEN) in comparison with the values before treatment, but remained still considerably elevated (p<0.001; p<0.01) when compared with the healthy control. Results of this study indicate that the compensatory antiinflammatory response, expressed as elevated IL-10 activity, is induced as early as in the acute stage of skin lesions and lasts longer than clinical symptoms of drug-induced cutaneous reactions.


Assuntos
Interleucina-10/sangue , Dermatopatias/induzido quimicamente , Dermatopatias/imunologia , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Eritema Multiforme/induzido quimicamente , Eritema Multiforme/imunologia , Eritema Nodoso/induzido quimicamente , Eritema Nodoso/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Parapsoríase/imunologia , Síndrome de Stevens-Johnson/induzido quimicamente , Síndrome de Stevens-Johnson/imunologia , Urticária/induzido quimicamente , Urticária/imunologia , Vasculite/induzido quimicamente , Vasculite/imunologia
19.
Artigo em Inglês | MEDLINE | ID: mdl-15323158

RESUMO

Plasma concentrations of interleukin-2 (IL-2) and its soluble receptor (sIL-2R) were examined in 126 patients with drug-induced skin reactions: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), drug-induced urticaria (DU), hyperergic vasculitis (HV), Stevens-Johnsson syndrome and toxic epidermal necrolysis (SJS/TEN). The activity of both proteins were measured using immunoenzymatic ELISA method: a) in the acute stage of disease, before treatment was administered, and b) after clearing of skin symptoms, after treatment. In the acute stage of disease highly elevated mean concentrations of IL-2 and sIL-2R in all 6 groups of patients were found (p<0.001) in comparison with the control. After clearing of skin lesions IL-2 mean concentrations were lowered to the level not different significantly from the control (p>0.05), but slL-2R mean plasma concentrations, despite the deep decrease, were still highly significantly elevated in comparison with control values (p<0.001).


Assuntos
Toxidermias/etiologia , Epiderme/imunologia , Interleucina-2/sangue , Receptores de Interleucina-2/sangue , Pele/efeitos dos fármacos , Doença Aguda , Adolescente , Adulto , Idoso , Ensaio de Imunoadsorção Enzimática , Eritema Multiforme/induzido quimicamente , Eritema Nodoso/induzido quimicamente , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parapsoríase/induzido quimicamente , Síndrome de Stevens-Johnson/induzido quimicamente , Síndrome de Stevens-Johnson/etiologia , Fatores de Tempo , Urticária/induzido quimicamente , Vasculite/induzido quimicamente
20.
Artigo em Inglês | MEDLINE | ID: mdl-15323166

RESUMO

Plasma concentration of TNF-alpha and its type I receptor (p55TNF-R) was examined in 126 patients with drug-induced skin reactions using immunoenzymatic ELISA method. Patients were subdivided into 6 groups: maculopapular eruptions (ME), erythema multiforme (EM), erythema multiforme coexisting with erythema nodosum (EMN), hyperergic vasculitis (HV), Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN). In the acute clinical stage highly significant (p<0.001) or significant (p<0.01) elevation of mean plasma concentrations of the cytokine and its receptor was found in all examined groups in comparison with the control. Clearing of clinical symptoms was connected with considerable decrease (p<0.001, p<0.01) of mean plasma levels of the both proteins in comparison with the before treatment values. TNF-alpha concentrations still remained significantly more elevated than those observed in the control. The results indicate that plasma activity of TNF-alpha and its p55 receptor change with the clinical course of the examined drug-induced skin reactions, which suggests the partake of both proteins in the pathogenesis of these diseases.


Assuntos
Toxidermias/sangue , Imunoglobulina G/sangue , Receptores do Fator de Necrose Tumoral/sangue , Fator de Necrose Tumoral alfa/metabolismo , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Eritema/sangue , Eritema/induzido quimicamente , Etanercepte , Feminino , Humanos , Imunossupressores/sangue , Masculino , Pessoa de Meia-Idade , Parapsoríase/sangue , Parapsoríase/induzido quimicamente , Síndrome de Stevens-Johnson/sangue , Síndrome de Stevens-Johnson/induzido quimicamente , Síndrome de Stevens-Johnson/etiologia , Fatores de Tempo , Urticária/sangue , Urticária/induzido quimicamente , Vasculite/sangue , Vasculite/induzido quimicamente
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