RESUMEN
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.
Asunto(s)
Anestésicos Generales/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Analgésicos Opioides/efectos adversos , Anestésicos Intravenosos/efectos adversos , Atracurio/efectos adversos , Atracurio/análogos & derivados , Femenino , Fentanilo/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Bloqueantes Neuromusculares/efectos adversos , Periodo Perioperatorio , Valor Predictivo de las Pruebas , Propofol/efectos adversos , Remifentanilo/efectos adversos , Rocuronio/efectos adversos , Pruebas Cutáneas , Sugammadex/efectos adversos , Adulto JovenAsunto(s)
Acetato de Abiraterona/uso terapéutico , Alérgenos/efectos adversos , Antineoplásicos/uso terapéutico , Hipersensibilidad a las Drogas/diagnóstico , Neoplasias de la Próstata/tratamiento farmacológico , Acetato de Abiraterona/efectos adversos , Administración Oral , Antineoplásicos/efectos adversos , Hipersensibilidad a las Drogas/prevención & control , Exantema , Humanos , Hipersensibilidad Tardía , Inmunización , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Náusea , Neoplasias de la Próstata/complicaciones , VómitosAsunto(s)
Pustulosis Exantematosa Generalizada Aguda/diagnóstico , Antibacterianos/efectos adversos , Artroplastia de Reemplazo de Rodilla , Hipersensibilidad a las Drogas/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Piel/patología , Teicoplanina/efectos adversos , Pustulosis Exantematosa Generalizada Aguda/etiología , Alérgenos/inmunología , Antibacterianos/uso terapéutico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/etiología , Femenino , Humanos , Persona de Mediana Edad , Pruebas del Parche , Teicoplanina/inmunología , Teicoplanina/uso terapéuticoAsunto(s)
Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/etiología , Factores Inmunológicos/efectos adversos , Lenalidomida/efectos adversos , Anciano , Humanos , Masculino , Fenotipo , Pruebas CutáneasRESUMEN
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.