ABSTRACT
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.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Drug Hypersensitivity , Drug Therapy/methods , Omalizumab/adverse effects , Premedication , Immunoglobulin ESubject(s)
Abiraterone Acetate/therapeutic use , Allergens/adverse effects , Antineoplastic Agents/therapeutic use , Drug Hypersensitivity/diagnosis , Prostatic Neoplasms/drug therapy , Abiraterone Acetate/adverse effects , Administration, Oral , Antineoplastic Agents/adverse effects , Drug Hypersensitivity/prevention & control , Exanthema , Humans , Hypersensitivity, Delayed , Immunization , Male , Methylprednisolone/administration & dosage , Middle Aged , Nausea , Prostatic Neoplasms/complications , VomitingSubject(s)
Acute Generalized Exanthematous Pustulosis/diagnosis , Anti-Bacterial Agents/adverse effects , Arthroplasty, Replacement, Knee , Drug Hypersensitivity/diagnosis , Drug-Related Side Effects and Adverse Reactions/diagnosis , Skin/pathology , Teicoplanin/adverse effects , Acute Generalized Exanthematous Pustulosis/etiology , Allergens/immunology , Anti-Bacterial Agents/therapeutic use , Drug-Related Side Effects and Adverse Reactions/etiology , Female , Humans , Middle Aged , Patch Tests , Teicoplanin/immunology , Teicoplanin/therapeutic useABSTRACT
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.
Subject(s)
Anesthetics, General/adverse effects , Drug Hypersensitivity/diagnosis , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/adverse effects , Anesthetics, Intravenous/adverse effects , Atracurium/adverse effects , Atracurium/analogs & derivatives , Female , Fentanyl/adverse effects , Humans , Male , Middle Aged , Neuromuscular Blocking Agents/adverse effects , Perioperative Period , Predictive Value of Tests , Propofol/adverse effects , Remifentanil/adverse effects , Rocuronium/adverse effects , Skin Tests , Sugammadex/adverse effects , Young AdultABSTRACT
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
ANTECEDENTES: La ausencia de estandarización del estudio de alergia a anestésicos generales y ausencia de verdaderos datos sobre el valor de las pruebas cutáneas en la mayoría de los fármacos empleados en anestesia general, así como la ausencia de reactivos disponibles comercialmente para poder realizar tests in vitro, continúa suponiendo un dilema para estudiar las reacciones perianestésicas. El objetivo de este estudio fue aportar un protocolo de pruebas de provocación con anestésicos generales para poder establecer un diagnóstico etiológico lo mas especifico posible, y determinar el valor predictivo de las pruebas cutáneas. MÉTODOS: Desde noviembre de 2008 a diciembre de 2018, fueron estudiados 29 pacientes con reacciones perioperatorias a medicamentos. RESULTADOS: Con este estudio, confirmamos el alto valor predictivo negativo (VPN) de las pruebas cutáneas (96-100%) en el caso del propofol, rocuronio y fentanilo. En nuestro conocimiento, este es el primer trabajo que describe pruebas de provocación con anestésicos generales, y en aportar el verdadero VPN de las pruebas cutáneas, lo que permite llegar a un diagnóstico más definitivo, y a una mayor seguridad en futuras cirugías. CONCLUSIONES: Valorando riesgos /beneficios y considerando la importancia de este grupo de medicamentos, concluimos que las pruebas de provocación controlada con anestésicos generales, son necesarias. Proponemos un protocolo diagnóstico de las reacciones perioperatorias por fármacos, que permita alcanzar un diagnóstico etiológico lo más certero posible, con el menor riesgo para el paciente
Subject(s)
Humans , Male , Female , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Anesthetics, General/adverse effects , Anesthesia, General/methods , Perioperative Care , Skin Tests , Propofol/adverse effects , Rocuronium/adverse effects , Fentanyl/adverse effects , Predictive Value of Tests , Anesthesia, General/standardsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Drug-Related Side Effects and Adverse Reactions , Acute Generalized Exanthematous Pustulosis/etiology , Teicoplanin/adverse effects , Anti-Bacterial Agents/adverse effectsSubject(s)
Anticoagulants/adverse effects , Drug Hypersensitivity/diagnosis , Heparin/adverse effects , Aged , Aged, 80 and over , Cross Reactions , Female , Humans , Male , Middle AgedABSTRACT
No disponible
