Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Drug Hypersensitivity , Drug Therapy/methods , Omalizumab/adverse effects , Premedication , Immunoglobulin ESubject(s)
Anaphylaxis/etiology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Drug Hypersensitivity/etiology , Excipients/adverse effects , SARS-CoV-2/immunology , Vaccines, Synthetic/adverse effects , 2019-nCoV Vaccine mRNA-1273 , Adult , Aged , Anaphylaxis/diagnosis , BNT162 Vaccine , Drug Hypersensitivity/diagnosis , Female , Humans , Male , Middle Aged , Skin Tests , Surveys and Questionnaires , mRNA VaccinesSubject(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)
Humans , Male , Female , Adult , Middle Aged , Aged , Anaphylaxis/etiology , Coronavirus Infections/prevention & control , Drug Hypersensitivity/etiology , Excipients/adverse effects , Severe acute respiratory syndrome-related coronavirus/immunology , Vaccines, Synthetic/adverse effects , Anaphylaxis/diagnosis , Drug Hypersensitivity/diagnosis , Skin Tests , Surveys and QuestionnairesSubject(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 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.
Subject(s)
Drug Hypersensitivity Syndrome/diagnosis , Liver/metabolism , Skin/pathology , Algorithms , Allopurinol/adverse effects , Anti-Bacterial Agents/adverse effects , Anticonvulsants/adverse effects , Comorbidity , Consensus , Drug Hypersensitivity Syndrome/drug therapy , Drug Hypersensitivity Syndrome/epidemiology , Eosinophilia , Expert Testimony , Humans , Leukocytosis , Liver/pathology , Risk Factors , Spain/epidemiologyABSTRACT
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: 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
ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS
Subject(s)
Humans , Drug Hypersensitivity Syndrome , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/prevention & control , Drug Hypersensitivity Syndrome/therapy , SpainABSTRACT
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
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Drug Hypersensitivity/epidemiology , Heparin/adverse effects , Heparin, Low-Molecular-Weight/adverse effects , Anticoagulants/adverse effects , Intradermal Tests/statistics & numerical data , Cross Reactions/immunology , Predictive Value of Tests , Thromboembolism/prevention & controlSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Drug Eruptions/diagnosis , Exanthema/diagnosis , Pyridines/adverse effects , Sulfones/adverse effects , Arthralgia/drug therapy , Arthralgia/pathology , Drug Eruptions/etiology , Drug Eruptions/immunology , Drug Eruptions/pathology , Etoricoxib , Exanthema/chemically induced , Exanthema/immunology , Exanthema/pathology , Female , Humans , Middle Aged , Osteoarthritis/drug therapy , Osteoarthritis/pathology , Patch TestsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Exanthema/complications , Exanthema/immunology , Axilla/injuries , Axilla/physiopathology , Ibuprofen/therapeutic use , Drug Hypersensitivity/complications , Drug Hypersensitivity/drug therapy , Drug Hypersensitivity/immunology , Aspartate Aminotransferases/therapeutic use , Alanine Transaminase/therapeutic use , Methylprednisolone/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Hypersensitivity/complicationsABSTRACT
No disponible
Subject(s)
Humans , Male , Urticaria/complications , Urticaria/diagnosis , Cannabis/adverse effects , Cannabis/toxicity , Lipids/administration & dosage , Rhinitis, Allergic, Seasonal/diagnosis , Skin Tests/methods , Urticaria/metabolism , Urticaria/prevention & control , Cannabis/classification , Cannabis/metabolism , Lipids , Rhinitis, Allergic, Seasonal/metabolism , Skin Tests/instrumentationABSTRACT
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.