Revisión de las reacciones de hipersensibilidad a antineoplásicos / Review of hypersensitivity reactions to antineoplastic agents

Objetivo Revisar las características y el manejo de las reacciones de hipersensibilidad causadas por agentes antineoplásicos. Método Se realizó una búsqueda bibliográfica en las bases de datos Pubmed y EMBASE de los últimos 10 años. Resultados Casi todos los quimioterápicos tienen potencial para causar una reacción de hipersensibilidad, pero determinados grupos han sido asociados con un mayor riesgo, como los derivados del platino, los taxanos, las asparraginasas, los anticuerpos monoclonales y las epipodofilotoxinas. Las manifestaciones clínicas de estas reacciones son variables e impredecibles incluyendo síntomas cutáneos, respiratorios, cardiacos y gastrointestinales. El mecanismo asociado con su desarrollo aún no se conoce en su totalidad. El diagnóstico se basa en los signos y síntomas que desarrolle el paciente y en la realización de pruebas cutáneas. El manejo de los pacientes que sufran una reacción de hipersensibilidad a un quimioterápico variará según el grado de severidad de la reacción, de la necesidad de continuar con el tratamiento y de las alternativas terapéuticas disponibles. Conclusiones Al producirse un incremento progresivo en la utilización de los agentes quimioterápicos, se puede esperar un aumento de la incidencia de las reacciones de hipersensibilidad. Los protocolos de desensibilización destacan como una alternativa que nos van a permitir reintroducir en la terapia del paciente el agente causal de la reacción de hipersensibilidad. Su utilización debe valorarse individualmente sopesando los beneficios y los riesgos (AU)

Objective To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. Method We conducted a search in the Pubmed and EMBASE databases for the last 10 years. Results Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients’ signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. Conclusions Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients’ therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits (AU)

Review of hypersensitivity reactions to antineoplastic agents.

OBJECTIVE: To review the characteristics and management of hypersensitivity reactions caused by antineoplastic agents. METHOD: We conducted a search in the Pubmed and EMBASE databases for the last 10 years. RESULTS: Almost all chemotherapeutic agents have the potential to cause hypersensitivity reactions, but some groups have been associated with increased risk, such as platinum compounds, taxanes, asparaginase, monoclonal antibodies and epipodophyllotoxins. The clinical manifestations of these reactions are variable and unpredictable, including symptoms affecting the skin and the pulmonary, cardiac and gastrointestinal systems. The mechanism associated with their development is not yet fully understood. Diagnosis is based on patients' signs and symptoms and skin testing. The management of patients who suffer a hypersensitivity reaction to a chemotherapeutic agent varies with the severity of the reaction, the need to continue treatment, and the availability of alternative therapies. CONCLUSIONS: Due to a progressive increase in the use of chemotherapeutic agents an increased incidence of hypersensitivity reactions is to be expected. Desensitisation protocols are a noteworthy alternative that make it possible to re-initiate patients' therapy with the causative agent of the hypersensitivity reaction. Their use should be assessed individually, weighing risks and benefits.

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation.

UNLABELLED: The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. MATERIAL AND METHODS: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 +/- 294 kcal/day and 98.6 +/- 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 +/- 307 kcal/day) and isonitrogenated (92 +/- 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. RESULTS: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. CONCLUSIONS: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified.

Parenteral nutrition supplemented with glutamine in patients undergoing bone marrow transplantation / Nutrición parenteral suplementada con glutamina en pacientes sometido a trasplante de médula ósea

The objective of the study is to evaluate if the administration of glutamine in parenteral nutrition (PN) solution reduces the need for antibiotics, the risk of liver disease and the duration of hospital stay in bone marrow transplantation. Material and methods: Retrospective observational study in 68 adult patients undergoing a bone marrow transplantation who required PN for mucositis. Of these patients, 40 were given PN with 2,063 ± 294 kcal/day and 98.6 ± 13.9 g of amino acids/day, supplemented with Lglutamine (13.5-27 g/day), and 28 were given isocaloric (1,966 ± 307 kcal/day) and isonitrogenated (92 ± 16.3 g of amino acids/day) PN with standard glutamine-free amino acid solution. Antibiotic consumption and duration of hospital stay were analysed. Of the total cohort, hepatic profile was studied at the beginning and on day 7 of PN in 50 patients without liver disease at the start of PN. Results: There were no differences between both groups with regard to total number and duration of antibiotics prescribed or hospital stay. Of the 50 patients without hepatic alterations at the beginning of PN, 2 patients in the control group and 5 in the glutamine group developed a hepatic profile compatible with liver disease secondary to PN. Comparing both groups, there were no differences in hepatic enzyme values. Conclusions: Supplementation with PN glutamine does not improve the variables studied, but the actual clinical use of glutamine in this haematological treatment should be studied further and its potential advantages identified (AU)

El objetivo del estudio es determinar si la administración de glutamina en la solución de nutrición parenteral (NP) disminuye la necesidad de antibióticos, el riesgo de hepatopatía y la duración de la estancia hospitalaria en trasplante de células hematológicas. Material y método: Estudio observacional retrospectivo, con 68 pacientes adultos sometidos a trasplante de células hematológicas, que precisaron NP por mucositis. De ellos, 40 pacientes recibieron NP con 2.063 ± 294 kcal/día y 98,6 ± 13,9 g de aminoácidos/día, suplementada con L-glutamina (13,5-27 g/día) y 28 recibieron una NP isocalórica (1.966 ± 307 kcal/día) e isonitrogenada (92 ± 16,3 g de aminoácidos/día) con solución de aminoácidos estándar libre de glutamina. Se analizó el consumo de antibióticos y la duración de la estancia hospitalaria. De la cohorte total, en 50 pacientes sin hepatopatía al inicio de la NP se estudió el perfil hepático al inicio y en el día 7 de la NP. Resultados: No hubo diferencias entre ambos grupos respecto al número total y duración de antibióticos prescritos, ni en estancia hospitalaria. De los 50 pacientes sin alteraciones hepáticas al inicio de la NP, 2 pacientes en el grupo control y 5 en el grupo glutamina desarrollaron un perfil hepático compatible con hepatopatía secundaria a NP. Comparando ambos grupos no hubo diferencias en los valores de enzimas hepáticas. Conclusiones: La suplementación con glutamina de NP no mejora las variables estudiadas, pero se debe continuar investigando el uso clínico real de glutamina en este tratamiento hematológico, identificando sus potenciales ventajas (AU)

[Role of new biological therapy in psoriasis treatment]. / Papel de los nuevos tratamientos biológicos en la psoriasis.

Psoriasis is an inflammatory disease mediated by immune system T cells. The use of current systemic immunosuppressive therapies is limited by an inability to maintain disease remission safely knowledge on. Advances in recombinant DNA technology and the increase in knowledge on psoriasis immunopathology knowledge have led to the development of numerous biologic agents for the treatment of the disease. In this review the mechanisms of action for these new agents, as well as their safety profiles and efficacy data have been analyzed.

Papel de los nuevos tratamientos biológicos en la psoriasis / Role of new biological therapy in psoriasis treatment

La psoriasis es una enfermedad inflamatoria crónica mediada por los linfocitos T del sistema inmune. El uso de las terapias inmunosupresoras actuales está limitado por la incapacidad para mantener una remisión segura de la enfermedad. La evolución en la tecnología del ADN recombinante junto con el avance en el conocimiento de la inmunopatología de la psoriasis han conducido al desarrollo de numerosos agentes biológicos para el tratamiento de esta enfermedad. En esta revisión se estudian los mecanismos de acción de estos nuevos agentes, así como su perfil de seguridad y eficacia (AU)