ABSTRACT
Drug hypersensitivity reactions are a diverse group of reactions mediated by the immune system after exposure to a drug. The Gell and Coombs classification divides immunologic DHRs into 4 major pathophysiologic categories based on immunologic mechanism. Anaphylaxis is a Type I hypersensitivity reaction that requires immediate recognition and treatment. Severe cutaneous adverse reactions (SCARs) are a group of dermatologic diseases that result from a Type IV hypersensitivity process and include drug reaction with eosinophilia and systemic symptom (DRESS) syndrome, Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP). Other types of reactions are slow to develop and do not always require rapid treatment. Emergency physicians should have a good understanding of these various types of drug hypersensitivity reactions and how to approach the patient regarding evaluation and treatment.
Subject(s)
Drug Hypersensitivity/physiopathology , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity/therapy , HumansABSTRACT
OBJECTIVE: Clopidogrel is a commonly used antiplatelet agent for the prevention of thromboembolic complications following neuroendovascular procedures, but anecdotal data have raised concern for the possibility that clopidogrel may induce severe, intolerable fatigue. The purpose of this study is to systematically investigate this phenomenon. METHODS: We performed a dual-institution, 9-year, retrospective study of patients undergoing clopidogrel therapy for neuroendovascular procedures. Patients were included only if their response to clopidogrel was assessed by platelet function testing using the VerifyNow P2Y12 (VNP) assay. Hyperresponse to clopidogrel was defined as P2Y12 reaction units ≤60. Patients were considered to have had clopidogrel-induced severe fatigue if the onset of symptoms followed the initiation of clopidogrel therapy; symptoms improved following a reduction in the dose of clopidogrel; and symptoms could not be attributed to any other medical explanation. RESULTS: Data were collected on 349 patients. Five patients (1.4%) met criteria for clopidogrel-induced severe fatigue. All 5 patients were female, ages 39-68. VNP assessments obtained while patients were symptomatic revealed hyperresponse to clopidogrel (0-22 P2Y12 reaction units). Symptoms improved in all 5 patients when the dose of clopidogrel was reduced by half. Notably, 30% of patients (n = 103) demonstrated a hyperresponse to clopidogrel on at least 1 VNP assessment, but 98 of these patients did not suffer from severe fatigue. CONCLUSIONS: A syndrome of severe fatigue and other constitutional symptoms is a rare but clinically significant side effect of hyperresponse to clopidogrel in patients undergoing neuroendovasular intervention.
Subject(s)
Clopidogrel/adverse effects , Drug Hypersensitivity/physiopathology , Fatigue/chemically induced , Platelet Aggregation Inhibitors/adverse effects , Adult , Aged , Endovascular Procedures , Female , Humans , Middle Aged , Neurosurgical Procedures , Platelet Function Tests , Purinergic P2Y Receptor Agonists/adverse effects , Receptors, Purinergic P2Y12 , Retrospective StudiesSubject(s)
Drug Hypersensitivity/physiopathology , Erythema Multiforme/physiopathology , Mucositis/physiopathology , Pneumonia, Mycoplasma/physiopathology , Acetaminophen/adverse effects , Adolescent , Analgesics, Non-Narcotic/adverse effects , Anti-Bacterial Agents/adverse effects , Child , Child, Preschool , Diagnosis, Differential , Drug Eruptions/etiology , Drug Eruptions/physiopathology , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Erythema Multiforme/etiology , Exanthema/chemically induced , Exanthema/physiopathology , Expectorants/adverse effects , Female , Hospitals, Pediatric , Humans , Ibuprofen/adverse effects , Male , Mucositis/chemically induced , Mycoplasma pneumoniae , Pneumonia, Mycoplasma/complications , Pneumonia, Mycoplasma/diagnosis , Stevens-Johnson Syndrome/etiology , Stevens-Johnson Syndrome/physiopathology , Tertiary Care CentersABSTRACT
Severe drug hypersensitivity reactions (DHRs) are often encountered by health care professionals (HCPs). We evaluated knowledge of doctors and pharmacists in the assessment and management of severe DHRs using a structured questionnaire. A cross-sectional study was conducted in 4 metropolitan hospital networks in Melbourne, Australia. A 13-question, scenario-based multiple-choice questionnaire to assess specific knowledge domains in drug hypersensitivity syndrome recognition, causality attribution, cross-reactivity patterns, appropriate diagnostic tests, and therapy was administered to HCPs of various vocation and specialty groups. Data were analyzed according to profession, self-reported experience, and preparedness in managing severe DHRs. Two hundred thirty-eight participants (45.0% senior doctors, 24.4% junior doctors, and 30.7% pharmacists) across a range of subspecialties achieved an overall median score of 7 (IQR, 5-8)-overall 55.6% correct responses to all questions-with senior doctors outperforming junior doctors and pharmacists (P < .001). The best performance by all participants was in DHR syndrome recognition (60.9%), and the poorest was in diagnostics/therapy (52.0%). HCP group and experience level were significantly associated with better performance in the knowledge domains of cross-reactivity and diagnostics/therapy (P = .003 and < .001, respectively), but not in the domains of syndrome recognition and causality attribution (P > .05). Levels of self-reported preparedness in DHR management were not associated with performance rates in any of the knowledge domains. This study demonstrated significant knowledge gaps in the recognition and management of severe drug hypersensitivity reactions. Targeted multidisciplinary education of staff caring for these patients is needed to improve knowledge gaps.
Subject(s)
Drug Hypersensitivity/epidemiology , Health Knowledge, Attitudes, Practice , Health Personnel/psychology , Australia , Cross Reactions , Cross-Sectional Studies , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , Drug Hypersensitivity/therapy , HumansABSTRACT
Recently, ustekinumab has been approved for the treatment of Crohn's disease and ulcerative colitis. Treatment is started with an intravenous induction dose, followed by a subcutaneous dosage. We present details of three patients with therapy-refractory Crohn's disease who experienced an immediate infusion reaction to intravenous administration of ustekinumab. In two of these patients a subsequent reaction to subcutaneous injections occurred. Clinical features and pathophysiology are discussed.
Subject(s)
Crohn Disease/drug therapy , Drug Hypersensitivity , Dyspnea , Ustekinumab , Adrenal Cortex Hormones/administration & dosage , Adult , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effects , Crohn Disease/immunology , Drug Administration Routes , Drug Hypersensitivity/etiology , Drug Hypersensitivity/physiopathology , Drug Hypersensitivity/therapy , Dyspnea/chemically induced , Dyspnea/drug therapy , Female , Histamine Antagonists/administration & dosage , Humans , Injection Site Reaction/drug therapy , Injection Site Reaction/etiology , Middle Aged , Remission Induction/methods , Treatment Outcome , Ustekinumab/administration & dosage , Ustekinumab/adverse effects , Withholding TreatmentABSTRACT
This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
Subject(s)
Anaphylaxis/diagnosis , Anaphylaxis/etiology , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Adult , Allergy and Immunology , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Bradykinin/adverse effects , Brazil , Child , Drug Hypersensitivity/physiopathology , Humans , IgA Deficiency/complications , Immunoglobulin E/immunology , In Vitro Techniques , Mastocytosis/complications , Preoperative Care , Risk Factors , Skin Tests/methods , Societies, Medical , Symptom Assessment , Terminology as Topic , Vasodilator Agents/adverse effectsABSTRACT
Abstract This second joint document, written by experts from the Brazilian Association of Allergy and Immunology (ASBAI) and Brazilian Society of Anesthesiology (SBA) concerned with perioperative anaphylaxis, aims to review the pathophysiological reaction mechanisms, triggering agents (in adults and children), and the approach for diagnosis during and after an episode of anaphylaxis. As anaphylaxis assessment is extensive, the identification of medications, antiseptics and other substances used at each setting, the comprehensive data documentation, and the use of standardized nomenclature are key points for obtaining more consistent epidemiological information on perioperative anaphylaxis.
Resumo Este segundo documento, escrito por especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória, tem por objetivo revisar os mecanismos fisiopatológicos, agentes desencadeantes (em adultos e crianças), assim como a abordagem diagnóstica durante e após o episódio. Por se tratar de uma avaliação abrangente, a identificação das medicações, antissépticos e outras substâncias usadas em cada região, registros detalhados, e nomenclatura padronizada são pontos fundamentais para a obtenção de dados epidemiológicos mais fidedignos sobre a anafilaxia perioperatória.
Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as TopicABSTRACT
RATIONALE: Although the cancer incidence continues to rise, cancer mortality has declined over the past decade, in large part due to more efficacious chemotherapeutic regimens thus, the ability to use first-line chemotherapeutic agents in the treatment of patients with cancer is crucial. Antineoplastic agents can potentially cause toxic and/or hypersensitivity reactions, that can have serious consequences. Anaphylaxis is a big pitfall in oncological patients; the most important aspect in diagnosing anaphylaxis is to precisely identify the offending agent to prevent future events. Paclitaxel (Taxol) is widely used as antitumor medication in the ovarian, breast, non-small-cell lung, and other cancers. Paclitaxel hypersensitivity reactions are frequently described in the literature, but fatalities are rarely reported. Due to the low solubility of paclitaxel, the compound requires dissolution in Cremophor EL, a derivative of castor oil. PATIENT CONCERNS: A 79-year-old man was affected by high-grade non-papillary urothelial carcinoma and underwent a radical cystectomy and prostatectomy with locoregional lymphadenectomy. DIAGNOSIS: Eight months later, relapse was detected, and penis amputation and left nephrostomy were performed. Multiple metastases to lymph nodes were detected. INTERVENTIONS: Palliative chemotherapy was started with Paclitaxel (110âmg) infused at a rate of 50âmL/h. Despite premedication with cetirizine dihydrochloride, dexamethasone, ondansetron, ranitidine, 20âmin after Paclitaxel infusion starts, the patient developed general distress, followed by cardiac arrest. OUTCOMES: The mechanism of fatal paclitaxel-associated hypersensitivity reaction is uncertain and its solvent vehicle Cremophor EL may be involved. Several mechanisms have been postulated: an IgE-mediated mast cell degranulation induced by paclitaxel or Cremophor EL, a non-IgE-mediated idiosyncratic mast cell degranulation by paclitaxel or by Cremophor EL, and complement activation. Severe hypersensitivity reactions with fatal outcome are considered rare. LESSONS: The unpredictability and often dramatic reactions of Taxol cause substantial anxiety for doctors and caretakers. They also represent a significant logistic and financial burden on hospitals. Despite premedication, skin testing, and desensitization protocols administration of taxane-based, chemotherapy cannot be considered safe and severe to fatal hypersensitivity reactions cannot be prevented.
Subject(s)
Drug Hypersensitivity/etiology , Glycerol/analogs & derivatives , Paclitaxel/adverse effects , Urologic Neoplasms/drug therapy , Aged , Drug Hypersensitivity/physiopathology , Glycerol/adverse effects , Glycerol/therapeutic use , Humans , Male , Mast Cells/metabolism , Paclitaxel/therapeutic use , Tryptases/blood , Urologic Neoplasms/surgeryABSTRACT
Abstract Experts from the Brazilian Association of Allergy and Immunology (ASBAI) and the Brazilian Society of Anesthesiology (SBA) interested in the issue of perioperative anaphylaxis, and aiming to strengthen the collaboration between the two societies, combined efforts to study the topic and to prepare a joint document to guide specialists in both areas. The purpose of the present series of two articles was to report the most recent evidence based on the collaborative assessment between both societies. This first article will consider the updated definitions, treatment and guidelines after a perioperative crisis. The following article will discuss the major etiologic agents, how to proceed with the investigation, and the appropriate tests.
Resumo Especialistas da Associação Brasileira de Alergia e Imunologia (ASBAI) e da Sociedade Brasileira de Anestesiologia (SBA) interessados no tema anafilaxia perioperatória reuniram-se com o objetivo de intensificar a colaboração entre as duas sociedades no estudo desse tema e elaborar um documento conjunto que possa guiar os especialistas de ambas as áreas. O objetivo desta série de dois artigos foi mostrar as evidências mais recentes alicerçadas na visão colaborativa entre as sociedades. Este primeiro artigo versará sobre as definições mais atuais, formas de tratamento e as orientações após a crise no perioperatório. No próximo artigo serão discutidos os principais agentes causais e a condução da investigação com testes apropriados.
Subject(s)
Humans , Child , Adult , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/etiology , Perioperative Period , Anaphylaxis/diagnosis , Anaphylaxis/etiology , Societies, Medical , Vasodilator Agents/adverse effects , In Vitro Techniques , Mastocytosis/complications , Brazil , Preoperative Care , Immunoglobulin E/immunology , Bradykinin/adverse effects , Skin Tests/methods , Risk Factors , IgA Deficiency/complications , Drug Hypersensitivity/physiopathology , Allergy and Immunology , Symptom Assessment , Anaphylaxis/physiopathology , Anesthesiology , Angioedema/chemically induced , Terminology as TopicSubject(s)
Airway Obstruction/chemically induced , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , Penicillins/adverse effects , Anti-Bacterial Agents/adverse effects , Female , Humans , Larynx/drug effects , Larynx/physiopathology , Middle Aged , Skin Tests/methods , Vocal Cords/physiopathologyABSTRACT
Anaphylactic reactions to protamine are quite rare and almost exclusively reported during cardiac surgery. In this report, we illustrate a rare case of protamine reaction after peripheral vascular surgery a couple of months after cardiac surgery and how the patient survived this critical complication.
Subject(s)
Anaphylaxis/chemically induced , Coronary Artery Bypass , Coronary Artery Disease/surgery , Drug Hypersensitivity/etiology , Heparin Antagonists/adverse effects , Peripheral Arterial Disease/surgery , Protamines/adverse effects , Vascular Grafting , Aged , Anaphylaxis/diagnosis , Anaphylaxis/physiopathology , Anaphylaxis/therapy , Cardiopulmonary Resuscitation , Coronary Artery Disease/diagnostic imaging , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , Drug Hypersensitivity/therapy , Extracorporeal Membrane Oxygenation , Humans , Male , Peripheral Arterial Disease/diagnostic imaging , Treatment OutcomeABSTRACT
This review provides an assessment of post-inhalation cough with therapeutic aerosols. Factors that increase cough may be mitigated through design of the drug, formulation, and device. The incidence of cough is typically less than 5% for drugs with a nominal dose less than 1 mg, including asthma and COPD therapeutics. Cough increases markedly as the dose approaches 100 mg. This is due to changes in the composition of epithelial lining fluid (e.g., increases in osmolality, proton concentration). Whether an individual exhibits cough depends on their degree of sensitization to mechanical and chemical stimuli. Hypersensitivity is increased when the drug, formulation or disease result in increases in lung inflammation. Cough related to changes in epithelial lining fluid composition can be limited by using insoluble neutral forms of drugs and excipients.
Subject(s)
Aerosols/adverse effects , Aerosols/chemistry , Cough/chemically induced , Drug Compounding/methods , Administration, Inhalation , Dose-Response Relationship, Drug , Drug Hypersensitivity/physiopathology , Humans , Hydrogen-Ion Concentration , Hypersensitivity , Nebulizers and Vaporizers , Osmolar ConcentrationABSTRACT
The sixth meeting of the International Society for Zinc Biology (ISZB-2019) was held on September 9-13, 2019 in Kyoto, Japan. The meeting attracted 215 participants, had four plenary speakers, ten scientific symposia, two oral sessions, and one poster discussion session. In this chapter, we describe the outcomes and events of this very successful meeting.
Subject(s)
Congresses as Topic , Drug Hypersensitivity/physiopathology , Zinc/physiology , Humans , Internationality , Japan , Societies, Medical , Zinc/administration & dosageABSTRACT
BACKGROUND: Propofol is a short-acting anesthetic used to induce sedation in various ambulatory and inpatient surgical procedures. It is a US Food and Drug Administration approved lipid-based intravenous hypnotic agent, which has been used clinically for the induction and maintenance of anesthesia for over 3 decades. In addition to general anesthesia, it is used to sedate patients undergoing mechanical ventilation or short procedures such as endoscopy, transesophageal echocardiogram, and abscess drainage. An infrequent but serious complication of propofol is acute pancreatitis (AP), with potentially significant morbidity and possible mortality. In this review, we will discuss the proposed mechanisms of AP secondary to propofol, a number of reported cases, studies conducted, and treatment strategies. AREAS OF UNCERTAINTY: There are several case reports in the literature that have shown an association between propofol and pancreatitis. The exact mechanism behind propofol-induced pancreatitis is not fully understood, but proposed mechanisms include hypertriglyceridemia (HTG), hypersensitivity, or direct pancreatic toxicity of the drug. Although the association of propofol and pancreatitis has not been proven conclusively, clinicians should be aware of this possible rare complication to prevent the devastating consequences of AP. DATA SOURCES: We gathered articles on previously documented case reports and up-to-date studies on propofol-induced pancreatitis by searching databases such as PubMed and Google Scholar. RESULTS: Based on previous studies and case reports, we suggest that propofol should be added to a list of drugs having a direct association with AP. CONCLUSIONS: Although, the mechanism of propofol-induced pancreatitis is not fully understood, and the causal relationship of propofol-induced hypertriglyceridemia or idiosyncratic drug reaction has remained unproven. Clinicians should be aware of the association between propofol and pancreatitis, and any patient presenting with abdominal pain after propofol infusion should be evaluated for AP and treated promptly to avoid complications.
Subject(s)
Anesthetics, Intravenous/adverse effects , Pancreatitis/chemically induced , Pancreatitis/physiopathology , Propofol/adverse effects , Drug Hypersensitivity/physiopathology , Humans , Hypertriglyceridemia/physiopathologyABSTRACT
The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Drug Hypersensitivity/pathology , Aspirin/adverse effects , Drug Hypersensitivity/classification , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , HumansABSTRACT
The anti-IgE Omalizumab may be helpful to treat clopidogrel hypersensitivity without stopping thienopyridine administration in patients requirining continuous antiplatellet therapy after coronary stent placement.
Subject(s)
Clopidogrel/adverse effects , Coronary Artery Disease/surgery , Coronary Restenosis/prevention & control , Drug Hypersensitivity , Omalizumab/administration & dosage , Percutaneous Coronary Intervention/adverse effects , Urticaria , Aged , Anti-Allergic Agents/administration & dosage , Anti-Allergic Agents/immunology , Aspirin/administration & dosage , Aspirin/adverse effects , Clopidogrel/administration & dosage , Drug Hypersensitivity/drug therapy , Drug Hypersensitivity/etiology , Drug Hypersensitivity/physiopathology , Drug Therapy, Combination/methods , Drug-Eluting Stents , Female , Humans , Omalizumab/immunology , Percutaneous Coronary Intervention/instrumentation , Percutaneous Coronary Intervention/methods , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effects , Treatment Outcome , Urticaria/chemically induced , Urticaria/drug therapyABSTRACT
PURPOSE OF THE STUDY: This study investigates spontaneous adverse drug reactions (ADRs) to glucosamine and chondroitin in the Australian population between 2000 and 2011, with a primary focus on hypersensitivity reactions. STUDY DESIGN: Case reports of ADR to glucosamine and chondroitin sent to the Therapeutic Goods Administration between 2000 and 2011 were obtained and analysed. The demographic information and severity of the ADR were recorded for individual ADR cases. These reactions were classified according to the Brown et al grading system for generalised hypersensitivity reactions. This included mild hypersensitivity reactions (generalised erythema, urticaria and angioedema) through to moderate hypersensitivity reactions (wheeze, nausea, vomiting, dizziness (presyncope), diaphoresis, chest or throat tightness and abdominal pain), and more severe reactions (hypotension, confusion and collapse). RESULTS: In this study of 366 ADRs to glucosamine and chondroitin preparations, 71.85% of cases (n=263) were found to have hypersensitivity reactions. Of these 263 cases, 92 cases were classified as mild (eg, pruritus, urticaria and lip oedema), 128 cases classified as moderate (such as dyspnoea, nausea and abdominal pain), and 43 cases classified as severe (including amnesia, gait disturbance, somnolence and hypotension). It is not clear whether the patients involved had a known shellfish allergy or underlying atopy. CONCLUSION: Results of this investigation support the need for clear labelling on glucosamine and chondroitin preparations to raise awareness of possible adverse events for those predisposed to allergy or atopy in response to shellfish.
Subject(s)
Chondroitin/adverse effects , Drug Hypersensitivity , Drug Labeling , Drug-Related Side Effects and Adverse Reactions , Glucosamine/adverse effects , Osteoarthritis , Analgesics/adverse effects , Analgesics/therapeutic use , Australia/epidemiology , Chondroitin/therapeutic use , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity/etiology , Drug Hypersensitivity/physiopathology , Drug Labeling/methods , Drug Labeling/standards , Drug-Related Side Effects and Adverse Reactions/diagnosis , Drug-Related Side Effects and Adverse Reactions/epidemiology , Drug-Related Side Effects and Adverse Reactions/etiology , Drug-Related Side Effects and Adverse Reactions/physiopathology , Female , Glucosamine/therapeutic use , Humans , Male , Middle Aged , Needs Assessment , Nonprescription Drugs/adverse effects , Nonprescription Drugs/therapeutic use , Osteoarthritis/drug therapy , Osteoarthritis/epidemiologyABSTRACT
OBJECTIVE: Samter's triad is the combination of asthma, aspirin sensitization, and nasal polyposis. Few data are available on the use of omalizumab in this disease. The study aimed to describe the impact of omalizumab on clinical and functional parameters and the quality of life of a series of patients with Samter's triad. Moreover, we aimed to provide a review of the literature on this topic. PATIENTS AND METHODS: We retrospectively described four patients with Samter's triad undergoing omalizumab therapy. Clinical, functional, and immunological data of these patients were collected at baseline and follow-up. RESULTS: Reduction of asthma exacerbations and salbutamol rescue therapy were observed in all patients after anti-IgE treatment together with an improvement in the quality of life. A significant improvement in FEV1, FVC, and FEF25-75 was observed. No major side-effects were observed. A total of 14 studies regarding omalizumab in aspirin-exacerbated respiratory diseases were included in the review, comprising 78 patients. All studies reported a good efficacy in improving asthma control; restoration of aspirin tolerance was repeatedly reported. CONCLUSIONS: The results of our case series and review of the literature suggest that omalizumab effectively improves asthma control, lung function tests, and quality of life in patients with Samter's triad.
Subject(s)
Anti-Asthmatic Agents/therapeutic use , Asthma, Aspirin-Induced/drug therapy , Nasal Polyps/drug therapy , Omalizumab/therapeutic use , Adult , Aged , Asthma/drug therapy , Asthma/physiopathology , Asthma, Aspirin-Induced/physiopathology , Disease-Free Survival , Drug Hypersensitivity/drug therapy , Drug Hypersensitivity/physiopathology , Female , Forced Expiratory Volume , Humans , Male , Maximal Midexpiratory Flow Rate , Middle Aged , Nasal Polyps/physiopathology , Respiratory Hypersensitivity/drug therapy , Respiratory Hypersensitivity/physiopathology , Sino-Nasal Outcome Test , Therapeutics , Vital CapacityABSTRACT
While opioids represent one of the most common medication allergy labels, these labels are often unsubstantiated in clinical practice. The removal of erroneous opioid allergy labels has a unique importance in the population with acute or chronic pain. The current approach to patients with pseudo-allergy to opioids is switching to an alternative opioid with less histamine release. Thus, allergy labels to relatively lower potency opioids such as codeine may be feasibly result in the prescription of stronger medications like fentanyl that would otherwise not be indicated.This narrative review provides an overview of the epidemiology and clinical manifestations of opioid allergy labels commonly encountered by pain management practitioners along with recommendations for evaluation and management.A literature search of PubMed was performed using the comprehensive MeSH term, "Opioid Allergy".In recent years, it has become apparent that a substantial proportion of patients labeled as opioid allergic are found to be tolerant of these agents. Opioid skin testing and IgE assays are of limited application. DPT is the yet underutilized gold standard for diagnosis. There is also an increasing call for studies evaluating basophil activation testing in opiate allergy.Opioid allergy labels require a closer look especially in view of the current opioid epidemic. The low likelihood of true reactivity, combined with the conceivable clinical relevance of an opioid allergy label, calls for further characterization of this label in populations with acute or chronic pain diagnoses. Future directions should include larger prospective studies with systematic evaluation and classification of opioid allergy labels to determine future viability of opioid use.AbbreviationsEHRelectronic health recordNMBAneuromuscular blocking agentIgEimmunoglobulin EMCmast cellGPCRG-protein coupled receptorMRGPRX2mas-related G-protein receptorQAIquaternary ammonium ionsSCARsevere cutaneous adverse reactionAGEPacute generalized exanthematous pustulosisSDRIFEsymmetrical drug-related intertriginous and flexural exanthemaBATbasophil activation testingDPTdrug provocation testing.
Subject(s)
Analgesics, Opioid/adverse effects , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , Drug Hypersensitivity/epidemiology , HumansABSTRACT
BACKGROUND: Paracetamol is a widely used analgesic to which hypersensitivity reactions are rare. Reactions to paracetamol may be due to the pharmacological effects of cyclooxygenase-1 inhibition or, more rarely, due to a selective allergy against paracetamol. OBJECTIVE: This article aims to review the current literature in the context of two cases seen in the authors' allergy practice. DISCUSSION: Paracetamol allergy is uncommon and, as a result, may be overlooked as a cause for immediate hypersensitivity, which can lead to a significant delay in diagnosis. Currently, specialist referral for a supervised oral challenge is required for formal diagnosis.