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 JovenRESUMEN
BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.
Asunto(s)
Síndrome de Hipersensibilidad a Medicamentos/diagnóstico , Hígado/metabolismo , Piel/patología , Algoritmos , Alopurinol/efectos adversos , Antibacterianos/efectos adversos , Anticonvulsivantes/efectos adversos , Comorbilidad , Consenso , Síndrome de Hipersensibilidad a Medicamentos/tratamiento farmacológico , Síndrome de Hipersensibilidad a Medicamentos/epidemiología , Eosinofilia , Testimonio de Experto , Humanos , Leucocitosis , Hígado/patología , Factores de Riesgo , España/epidemiologíaAsunto(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)
Anafilaxia/etiología , Vacunas contra la COVID-19/efectos adversos , COVID-19/prevención & control , Hipersensibilidad a las Drogas/etiología , Excipientes/efectos adversos , SARS-CoV-2/inmunología , Vacunas Sintéticas/efectos adversos , Vacuna nCoV-2019 mRNA-1273 , Adulto , Anciano , Anafilaxia/diagnóstico , Vacuna BNT162 , Hipersensibilidad a las Drogas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Cutáneas , Encuestas y Cuestionarios , Vacunas de ARNmRESUMEN
BACKGROUND: Our objective was to ascertain the degree of adherence to recommendations made to patients with anaphylaxis, most of whom were attended in our allergy outpatient clinic. METHODS: A questionnaire was sent to 1512 patients who had experienced anaphylaxis and completed by 887. The chosen definition of anaphylaxis was that of the National Institute of Allergy and Infectious Diseases and the Food Allergy and Anaphylaxis Network Symposium. We evaluated the prescription, purchase, and use of epinephrine auto-injectors and oral drugs, as well as the avoidance of allergens involved in previous anaphylaxis episodes. RESULTS: Most patients (94.53%) reported that they had received advice on avoidance of responsible allergens after their allergy workup. Epinephrine auto-injectors and oral drugs were prescribed according to the subtype of anaphylaxis. Only 30.74% of patients used the epinephrine auto-injector; 54.26% took oral medication. Most patients (88.3%) avoided the allergen. CONCLUSIONS: Despite general agreement that anaphylaxis occurring in the community should be treated with epinephrine auto-injectors, use of these devices to treat recurrences was low in our patients. Oral medication intake was more common than the epinephrine auto-injector in all subtypes. In order to increase adherence to epinephrine auto-injectors, it is necessary to think beyond the measures recommended during regular visits to allergy outpatient clinics.
Asunto(s)
Anafilaxia/terapia , Autoadministración , Adolescente , Adulto , Niño , Epinefrina/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(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 CutáneasAsunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Erupciones por Medicamentos/diagnóstico , Exantema/diagnóstico , Piridinas/efectos adversos , Sulfonas/efectos adversos , Artralgia/tratamiento farmacológico , Artralgia/patología , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/inmunología , Erupciones por Medicamentos/patología , Etoricoxib , Exantema/inducido químicamente , Exantema/inmunología , Exantema/patología , Femenino , Humanos , Persona de Mediana Edad , Osteoartritis/tratamiento farmacológico , Osteoartritis/patología , Pruebas del ParcheRESUMEN
H1-antihistamines are probably the most frequently used drugs in allergic diseases, with widely established efficacy, tolerance, and safety. We report a patient with urticaria due to ingestion of ebastine and fexofenadine. Skin prick tests, patch tests, and basophil activation tests with the implicated drugs and antihistamines from other families were negative. The oral challenges with the implicated antihistamines and other antihistamines tested were positive, but the patient tolerated an oral challenge with cetirizine. We present a patient with urticaria induced by different antihistamines in whom the diagnosis was established by oral challenge. The mechanism of sensitization remains unclear.