Estudio observacional transversal de alergia a medicamentos en pacientes hospitalizados / Cross-sectional observational study of drug allergy in hospitalized patients

OBJETIVO: Conocer la prevalencia de alergia a fármacos en pacientes hospitalizados de nuestro medio y las características de las reacciones que presentaron y del diagnóstico realizado a estos pacientes. MÉTODO: Estudio observacional transversal llevado a cabo en pacientes hospitalizados en el Hospital Clínico Universitario Lozano Blesa de Zaragoza mediante una encuesta cumplimentada por los investigadores. RESULTADOS: Se incluyeron 283 pacientes hospitalizados, con una media de edad de 72,02±14,62 años y una distribución de sexos de 60,1 % hombres y 39,9 % mujeres. Refirieron ser alérgicos a medicamentos 42 de ellos (14,8 %). Se observaron diferencias significativas al analizar el sexo de los pacientes, siendo más frecuente en las mujeres (22,1 % vs 10,0 %) con una OR 2,557. Los diagnósticos de alergia a medicamentos fueron realizados por un alergólogo (33,3 %), médico de atención primaria (38,1 %) u otro especialista (19,0 %). Un 33,3 % de las personas disponía de un informe médico y un 71,4 % afirmaba llevarlo siempre consigo. Un 14,3 % indicó llevar alguna medalla, pulsera o alerta en la cartera. Uno de los participantes presentó una reacción alérgica a levofloxacino durante el ingreso. CONCLUSIONES: Se ha observado una mayor frecuencia de alergia a medicamentos en mujeres. El diagnóstico de alergia a medicamentos fue realizado en un tercio de los pacientes por un alergólogo. Un tercio de las personas que referían ser alérgicas disponía de un informe médico y, de éste, un 71,4 % lo lleva siempre consigo. Uno de los pacientes participantes presentó una reacción alérgica a medicamentos durante el ingreso

OBJETIVO: Conocer la prevalencia de alergia a fármacos en pacientes hospitalizados de nuestro medio y las características de las reacciones que presentaron y del diagnóstico realizado a estos pacientes. MÉTODO: Estudio observacional transversal llevado a cabo en pacientes hospitalizados en el Hospital Clínico Universitario Lozano Blesa de Zaragoza mediante una encuesta cumplimentada por los investigadores. RESULTADOS: Se incluyeron 283 pacientes hospitalizados, con una media de edad de 72,02±14,62 años y una distribución de sexos de 60,1 % hombres y 39,9 % mujeres. Refirieron ser alérgicos a medicamentos 42 de ellos (14,8 %). Se observaron diferencias significativas al analizar el sexo de los pacientes, siendo más frecuente en las mujeres (22,1 % vs 10,0 %) con una OR 2,557. Los diagnósticos de alergia a medicamentos fueron realizados por un alergólogo (33,3 %), médico de atención primaria (38,1 %) u otro especialista (19,0 %). Un 33,3 % de las personas disponía de un informe médico y un 71,4 % afirmaba llevarlo siempre consigo. Un 14,3 % indicó llevar alguna medalla, pulsera o alerta en la cartera. Uno de los participantes presentó una reacción alérgica a levofloxacino durante el ingreso. CONCLUSIONES: Se ha observado una mayor frecuencia de alergia a medicamentos en mujeres. El diagnóstico de alergia a medicamentos fue realizado en un tercio de los pacientes por un alergólogo. Un tercio de las personas que referían ser alérgicas disponía de un informe médico y, de éste, un 71,4 % lo lleva siempre consigo. Uno de los pacientes participantes presentó una reacción alérgica a medicamentos durante el ingresos

Clinical Characteristics of Intravenous PEG-Asparaginase Hypersensitivity Reactions in Patients Undergoing Treatment for Acute Lymphoblastic Leukemia [Formula: see text].

BACKGROUND: Asparaginase poses a substantial risk for hypersensitivity reactions during and after administration; however, these reactions vary by asparaginase formulation and administration route. It is imperative that nurses be knowledgeable of clinical symptoms associated with intravenous (IV) monomethoxypolyethylene glycol (PEG)-asparaginase reactions, as well as potential reaction timing. PURPOSE: This single institution retrospective study describes the clinical factors among patients with IV PEG-asparaginase hypersensitivity reactions. METHODS: Reaction frequency and severity, dose, phase of treatment, and time between infusion initiation and reaction were collected on patients identified as having an IV PEG-asparaginase hypersensitivity reaction while undergoing acute lymphoblastic leukemia treatment. RESULTS: Sixty-three patients (12.8%) developed a hypersensitivity reaction to IV PEG-asparaginase, with the reaction occurring during a median of 3 doses in both risk arms. Reactions were noted ≤60 minutes after infusion initiation in 98% of patients, and no reactions were fatal. CONCLUSION: Nurses should carefully observe patients throughout the infusion and anticipate adverse reactions, particularly during the first 3 doses and first 10 minutes of each infusion. Patient and family education should include the rare risk of delayed reactions.

From the Children's Oncology Group: Evidence-Based Recommendations for PEG-Asparaginase Nurse Monitoring, Hypersensitivity Reaction Management, and Patient/Family Education.

PEG-aspariginase is a backbone chemotherapy agent in pediatric acute lymphoblastic leukemia and in some non-Hodgkin lymphoma therapies. Nurses lack standardized guidelines for monitoring patients receiving PEG-asparaginase and for educating patients/families about hypersensitivity reaction risks. An electronic search of 6 databases using publication years 2000-2015 and multiple professional organizations and clinical resources was conducted. Evidence sources were reviewed for topic applicability. Each of the final 23 sources was appraised by 2 team members. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assign a quality and strength rating for each recommendation. Multiple recommendations were developed: 4 relating to nurse monitoring of patients during and after drug administration, 8 guiding hypersensitivity reaction management, and 4 concerning patient/family educational content. These strong recommendations were based on moderate, low, or very-low-quality evidence. Several recommendations relied on generalized drug hypersensitivity guidelines. Additional research is needed to safely guide PEG-asparaginase monitoring, hypersensitivity reaction management, and patient/family education. Nurses administering PEG-asparaginase play a critical role in the early identification and management of hypersensitivity reactions.

Nursing Care of Patients Undergoing Chemotherapy Desensitization: Part II.

Chemotherapy desensitization protocols are safe, but labor-intensive, processes that allow patients with cancer to receive medications even if they initially experienced severe hypersensitivity reactions. Part I of this column discussed the pathophysiology of hypersensitivity reactions and described the development of desensitization protocols in oncology settings. Part II incorporates the experiences of an academic medical center and provides a practical guide for the nursing care of patients undergoing chemotherapy desensitization.
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Variabilidad en el registro de alergias por profesionales sanitarios en un hospital de tercer nivel / Variability in allergies registration done by healthcare professionals in a third level hospital

Introducción: El objetivo del estudio es cuantificar el grado de coincidencia en las alergias registradas en las distintas aplicaciones informáticas disponibles para cada profesional sanitario (médicos, personal de enfermería y farmacéuticos). Métodos: Estudio observacional descriptivo retrospectivo de 3 meses de duración en el que participaron todas las Unidades Clínicas con Sistema de Distribución de Medicamentos en Dosis Unitarias. Se incluyeron a todos los pacientes ingresados con al menos una alergia registrada en cualquiera de las tres aplicaciones informáticas utilizadas por los distintos profesionales sanitarios. Se cuantificaron el porcentaje de alergias registradas en una, dos o tres aplicaciones disponibles. Resultados: Se incluyeron 767 pacientes en los que se registraron 1.257 alergias. La mediana de edad fue 59 años y el 60,76% eran mujeres. El 70,09% de las alergias registradas fueron farmacológicas. El registro de alergias únicamente a través de la aplicación de enfermería fue el más frecuente (36,67%). El porcentaje de alergias registradas por los tres profesionales sanitarios fue el 7,88%. Haciendo distinción en el tipo de alergia, solamente el 0,80% de las alergias no farmacológicas fueron registradas simultáneamente por los tres profesionales sanitarios frente al 10,90% de las farmacológicas. El personal médico contribuyó al registro del 59,29% de las alergias farmacológicas y del 10,65% de las no farmacológicas. Discusión: Existe una gran variabilidad en el registro de alergias por parte del personal sanitario y escasa concordancia en las registradas por cada tipo de profesionales. El personal médico únicamente registró una décima parte de las alergias no farmacológicas

Introduction: The purpose of the study is to quantify the degree of coincidence in the allergies registered in the different computer applications available to each healthcare professional (doctors, nursing staff and pharmacists). Methods: It was conducted a three- month retrospective descriptive and observational study which included the participation of all Clinical Units with Medication Dispensing System in Single Doses. All in-patients with, at least, one allergy registered in any of the three computer applications used by the different healthcare professionals were included in the study. The percentage of allergies registered in one, two or three of the available applications was quantified. Results: 767 patients were included, among whom 1,257 allergies were recorded. The average age was 59 years and 60.76% were women. 70.09% of the recorded allergies were drug-related. The majority of allergies were just registered through the nursing application (36.67%). The percentage of allergies recorded by the three kinds of healthcare professionals was 7.88%. Differentiating the type of allergy, only 0.80% of non drug-related allergies were registered simultaneously by all three healthcare professionals in comparison with 10.90% of drug-related allergies. Medical staff recorded 59.29% of drug-related allergies and 10.65% of non drug-related allergies. Discussion: There is a high variability in the recording of allergies by the healthcare professionals and also a lack of concordance in those recorded by each type of professional. Medical staff only recorded 10% of non drug-related allergies

Organophosphate exposure with pseudocholinesterase deficiency.

A 36-year-old correctional officer was exposed to lice while at work and self-treated with chlorpyrifos, an organophosphate. The correctional officer applied chlorpyrifos to her entire body and did not wash it off for 8 to 12 hours. Eight hours after the initial application, the correctional officer developed abdominal cramps, diarrhea, sweating, excessive salivation, frequent urination, and increased bronchial secretions. After a phone consultation with the occupational health clinic, the correctional officer reported to the emergency department, was diagnosed with organophosphate toxicity, and was treated with atropine. Later testing revealed that the correctional officer had pseudocholinesterase deficiency.

Managing hypersensitivity to asparaginase in pediatrics, adolescents, and young adults.

Hypersensitivity reactions to chemotherapeutic drugs have been documented for numerous cancer therapies. Clinical hypersensitivity to Escherichia coli asparaginase has been reported to range from 0% to 75%. Throughout the United States, nurses assume frontline responsibility for the assessment of asparaginase-related hypersensitivity reactions. It is essential that nurses educate themselves on the signs and symptoms of asparaginase-related hypersensitivity reactions as well as current supportive care approaches. The purpose of this review is to summarize acute lymphoblastic leukemia and the role of asparaginase and the pathology of allergic reactions. We will also update nurses on the differences in asparaginase preparations including dosing, half-life, rates of hypersensitivity, and routes of administration. A summary of current management and supportive care strategies will be provided as will a discussion of the relationship between allergy, antibodies, and asparaginase activity.

The impact of infusion reactions associated with monoclonal antibodies in metastatic colorectal cancer: a European perspective.

BACKGROUND AND OBJECTIVES: Published data on the clinical and economic impact of infusion reactions to monoclonal antibodies are limited. This study investigated oncologists' and oncology nurses' opinions about resource use associated with infusion reactions and the impact on patient management in Europe. METHODS: Eighty oncologists and nurses from Denmark, France, Germany, Greece, Italy, Spain, Sweden and the UK currently treating patients with metastatic colorectal cancer were interviewed by telephone using a 27-item questionnaire developed for this study. RESULTS: The mean estimated number of staff (physicians and nurses) involved in managing an infusion reaction was 1.97 for a grade 1, 2.35 for a grade 2, 3.6 for a grade 3 and 5.3 for a grade 4 reaction. In respondents' experiences, most patients with grade 3 infusion reactions (73.4%) were admitted to hospital for treatment; 82.5% of those with grade 4 infusion reactions were treated in intensive care. The estimated duration of hospital treatment was 13.3 ± 29 h for a grade 3 infusion reaction, increasing to 48.1 ± 43.7 h for a grade 4 infusion reaction. CONCLUSIONS: According to respondents, management of infusion reactions led to substantial resource use, which increased with the severity of the reaction. More severe reactions also led to anxiety in patients and distress to staff.

Creative strategies to improve patient safety: allergies and adverse drug reactions.

Approximately 770,000 Americans are hospitalized and suffer adverse drug events (ADEs) costing billions of dollars each year. An ADE occurs when a patient is injured by an adverse drug reaction. Improved medication administration could prevent about 2.5 million ADEs (Institute of Medicine, 2004). This project provided an education for patients and nurses and a medication fact sheet. Outcomes included updating allergy records, improving medication safety knowledge, and improving nurses' adverse drug reactions and allergy reports.

Chemotherapy and biotherapy-induced hypersensitivity reactions.

Nearly all chemotherapy and biotherapy drugs used in cancer treatment today can cause hypersensitivity reactions. Certain groups of drugs frequently associated with these reactions include the asparaginases, taxanes, platinum compounds, epipodophyllotoxins, and the monoclonal antibodies. Recognizing and managing hypersensitivity reactions are critical when caring for patients receiving these drugs because the reactions are potentially life-threatening. A thorough understanding of the drugs is necessary to assist the nurse in prevention, early recognition, and timely management.

[Reactions to infliximab infusions in dermatologic patients: consensus statement and treatment protocol. Working Group of the Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología ]. / Reacciones a la infusión de infliximab en pacientes dermatológicos. Grupo de Estudio, Grupo Español de Psoriasis de la Academia Española de Dermatología y Venereología.

Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor alpha and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biological agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab.

Apósito de espuma de poliuretano. Evaluación de su comportamiento terapéutico en el tratamiento de úlceras crónicas de moderada a altamente exudativas / Polyurethane Foam Dressing Evaluation of this dressing’s therapeutic behavior in the treatment of chronic ulcers having a moderate to high exudation level

Se valora el comportamiento de los apósitos de espuma de poliuretano Skinfoam®, en el tratamiento de úlceras por presión y úlceras vasculares de moderada a altamente exudativas, mediante un estudio observacional de series de casos clínicos, multicéntrico, prospectivo y abierto. La duración del estudio fue de hasta 20 cambios de apósito o hasta la curación. En la visita inicial se anotaron los datos del paciente, incluyendo una valoración de las características de la lesión; en las visitas de cambio de apósito se registró la evolución de la lesión y de los cambios de apósito, y en la visita final se evaluaron las características finales de la lesión así como la valoración global del comportamiento del apósito. Se incluyeron 185 pacientes con una edad media de 75,5 años. Al final del estudio un 44,32% de los mismos no presentaba ninguna úlcera mientras que en los restantes constatamos una disminución importante del tamaño de la lesión, aumentando considerablemente el tejido de epitelización. La piel perilesional mejora en todos los aspectos y disminuye de forma estadísticamente significativa el eritema y el eczema. La fuga de exudado llegó a ser nula en el último cambio de apósito. Los pacientes manifiestan ausencia de dolor antes de finalizar el estudio. El grado de satisfacción global indicó bueno, muy bueno o excelente por el 95,15% de los profesionales y el 100% de los pacientes volvería a utilizarlo. Se concluye que el apósito en estudio Skinfoam® es efectivo en el tratamiento de las úlceras por presión y úlceras vasculares altamente exudativas, incluso en terapia compresiva, pudiendo ser el de elección(AU)

The authors evaluate the behavior of Skinfoam® Polyurethane Foam Dre-ssings in the treatment of bed sores and vascular ulcers having a moderate to high exudation level by means of a multi-centric, prospective, open, observational study of a series of clinical cases. The length of this study was up to 20 dressing changes or until the patient was cured. During the first visit with patients, the personnel recorded patient data including an evaluation of the characteristics of patient’s lesion; during visits to change dressings, the medical personnel recorded the evolution of the lesion and dressing changes; during the final visit, the medical personnel evaluated the final characteristics of the lesion as well as a global evaluation of the behavior of the dressing. This study included 185 patients who had an average age of 75.5. At the end of this study, 44.32% of these patients did not have any signs of an ulcer while among the other patients, the medical team noted an important decrease in the size of their lesions, with a considerable increase of tissue epithelization. The perilesional skin showed improvement in all aspects and erythema and eczema diminished in a statistically significant manner. The presence of exudation was null when the final dressing change occurred. Patients manifested a lack of pain before the end of this study. 85.15% of the professionals indicated a global satisfaction level of good, very good or excellent while 100% of the patients stated they would use his dressing again. The authors conclude that the dressing under study is effective in the treatment of bed sores and high exudation vascular ulcers; even in cases involving compressive therapy, this dressing could be the one chosen for application(AU)

Management of hypersensitivity reactions: a nursing perspective.

Infusion reactions occur commonly with the administration of monoclonal antibody therapy and can vary in severity. Oncology nurses have experience in hypersensitivity reactions with different chemotherapy agents, but with the increased use of monoclonal antibody therapy in the treatment of various cancers, knowledge of specific risk and management of reactions with these therapies is important. Anaphylactic reactions are mediated by IgE and anaphylactoid reactions are not; monoclonal antibody reactions are also considered to be associated with cytokine release syndrome, which has a specific constellation of symptoms associated with it. Infusion reactions, while common, have the potential to be distressing and frightening to oncology nurses. These challenging occurrences also can increase hospitalization costs. Strategies to manage reactions have included patient desensitization, alteration of infusion rates, skin testing, and the use of premedication. Baseline comprehensive assessments, including allergy history, are important in reducing or preventing hypersensitivity reactions. Clinical pathways or established guidelines can help to familiarize staff with appropriate responses to infusion reactions and nurses should be aware of the variety of symptoms which can indicate infusion or hypersensitivity reactions. Oncology nurses should understand the management of hypersensitivity and anaphylaxis; the Oncology Nursing Society and the American Heart Association have both published guidelines to assist practicing health-care professionals with the management of this potentially fatal adverse event. Knowledge of emergency drugs and mechanism of action is vital. Nurses should be aware of appropriate emergency response as well as management of delayed or biphasic hypersensitivity reactions. Oncology nurses should be well-prepared for these often common events.

Reacciones a la infusión de infliximab en pacientes dermatológicos / Reactions to Infliximab Infusions in Dermatologic Patients: Consensus Statement and Treatment Protocol

Infliximab, un anticuerpo monoclonal quimérico que se une y bloquea al factor de necrosis tumoral alfa, constituye el agente biológico más eficaz aprobado para el tratamiento de la psoriasis moderada a grave y se administra mediante infusión intravenosa, generalmente en Hospitales de Día de forma ambulatoria. Las reacciones infusionales, que pueden ser agudas y retardadas, constituyen el principal problema en la administración rutinaria de este fármaco, y están relacionadas con la inmunogenicidad del anticuerpo monoclonal que da lugar a la producción de anticuerpos dirigidos contra el mismo. Las reacciones infusionales a infliximab son en la mayoría de los casos no anafilácticas (mediadas por inmunoglobulina E [IgE]), lo que no excluye el retratamiento de los pacientes empleando protocolos específicos de prevención y tratamiento de las mismas. Existe una amplia experiencia sobre el uso de este fármaco en pacientes con enfermedades reumatológicas y enfermedad inflamatoria idiopática intestinal, lo que ha permitido desarrollar protocolos de tratamiento de las reacciones a la infusión aplicables a los pacientes dermatológicos, que constituyen un grupo cada vez más numeroso de los que son tratados con agentes biológicos por vía intravenosa. El objeto de la presente revisión es desarrollar un protocolo de tratamiento consensuado de las reacciones a la infusión en pacientes dermatológicos tratados con infliximab (AU)

Infliximab is a chimeric monoclonal antibody that binds to and blocks tumor necrosis factor α and is the most effective biologic agent approved for the treatment of moderate-to-severe psoriasis. It is administered by intravenous infusion, usually in day hospitals on an outpatient basis. The main problem with the administration of infliximab is the possibility of infusion reactions, which may be immediate or delayed; these reactions are related to the immunogenicity of this monoclonal antibody, leading to the production of anti-infliximab antibodies. Infusion reactions to infliximab are not usually anaphylactic (ie, they are not mediated by immunoglobulin E), and re-exposure of the patient using specific protocols to prevent and treat these reactions is therefore possible. The extensive experience in the use of infliximab for the treatment of rheumatic conditions and chronic inflammatory bowel disease has made it possible to develop infusion reaction management protocols; these can be applied to dermatologic patients, who constitute a growing proportion of patients treated with intravenous biologic agents. The aim of this review is to draw up a consensus protocol for the treatment of infusion reactions in dermatologic patients treated with infliximab (AU)