A Case Report and Pediatric Literature Review: Povidone as a Rare Cause of Anaphylaxis in Children.

Background: Povidone, a synthetic polymer commonly used in various products such as antiseptics, cosmetics, and medications, has been associated with allergic reactions, including anaphylaxis. Despite its widespread use, cases of povidone-induced anaphylaxis, especially in children, are under-recognized. This case report aims to highlight the importance of considering povidone allergy in pediatric patients presenting with anaphylaxis. Case Presentation: We describe a 3-year-old boy who experienced anaphylaxis following the application of povidone-iodine antiseptic solution to a leg wound. He presented with generalized urticaria, angioedema, dyspnea, and cough. Prompt diagnosis and management were initiated in the emergency department. He experienced the second anaphylaxis with povidone-containing eye drops prescribed during an ophthalmology visit. Conclusions: Povidone allergy should be considered in pediatric patients presenting with anaphylaxis, especially those with idiopathic reactions or multiple drug allergies. Clinicians should emphasize patient education on label reading and the provision of adrenaline autoinjectors to prevent life-threatening reactions associated with povidone exposure.

[Quality of life survey of 3,738 patients treated with intravitreal injections for age-related macular degeneration]. / Enquête de qualité de vie auprès de 3738 patients traités par injections intravitréennes pour leur dégénérescence maculaire liée à l'âge.

PURPOSE: To evaluate the peri- and post-intravitreal injection (IVI) symptoms reported by patients who have been repeatedly injected for age-related macular degeneration (AMD) and to analyze these according to the protocols of the injector. MATERIALS AND METHODS: Multi-center, cross-sectional, consecutive, analytical survey. RESULTS: The IVI protocols of 106 injectors differed in terms of the number of instillations of povidone-iodine, its contact time, and rinsing of the ocular surface post-injection. In total, 3,738 patients responded to the survey, 60.1% of whom were women; 36.4% had received more than 20 IVIs; 50.7% of patients reported irritation upon application of povidone-iodine. Post-IVI, depending on the symptom in question, between 44.8% and 57.4% of patients reported symptoms of ocular surface change. The number of instillations of povidone-iodine, its contact time with the ocular surface, and abundant rinsing post-IVI increased the immediate symptoms. Patients who received more IVIs were more prone to experiencing gritty eyes, and the incidence of acute pain increased in patients who had previously received over 20 IVIs. Women and patients previously treated for dry eye or glaucoma were at greater risk of worse symptoms. CONCLUSION: Comparing injecting centers' practices with patients' self-assessments showed an aggravation of symptoms of ocular surface changes related to povidone-iodine. This survey contributes to providing data for the implementation of a protocol to improve the quality of life of patients injected repeatedly for AMD.

Anaphylaxis to polyvinylpyrrolidone in eye drops administered to an adolescent

No disponible

Oclusión de arteria central retiniana tras facoemulsificación con anestesia peribulbar: hipótesis patogénicas / Central retinal artery occlusion after phacoemulsification under peribulbar anaesthesia: Pathogenic hypothesis

CASO CLÍNICO: Paciente de 77 años, intervenido de catarata en ojo derecho bajo anestesia peribulbar, sin complicaciones. Al día siguiente presenta edema palpebral severo con empeoramiento progresivo, secundario a reacción alérgica no conocida a la povidona yodada. A los 5 días presenta una resolución del cuadro alérgico, detectándose amaurosis y mancha rojo cereza. El eco-Doppler de troncos supraaórticos y el angio-TAC confirman una estenosis del 80% de la arteria carótida interna ipsilateral. DISCUSIÓN: Las oclusiones vasculares retinianas constituyen una complicación infrecuente de la anestesia loco-regional orbitaria. Su aparición obliga a descartar causas subyacentes, como enfermedad carotídea, así como a reflexionar sobre los factores locales o sistémicos que han colaborado en su aparición

CLINICAL CASE: A 77-year-old patient had uneventful cataract surgery in the right eye under peribulbar anaesthesia. The next day, a severe and progressive eyelid swelling was noted, caused by an unknown allergic reaction to povidone-iodine. The allergic signs dissapeared by the fifth day, but amaurosis and a cherry-red spot were detected. Doppler ultrasound and CT angiography confirmed an 80% ipsilateral internal carotid artery stenosis. DISCUSSION: Retinal vascular occlusion after orbital loco-regional anaesthesia is rare. When this complication occurs, carotid disease, and local or systemic factors, should be evaluated

Dermatitis de contacto por povidona yodada tras cirugía: un dilema diagnóstico / Postsurgical Contact Dermatitis due to Povidone Iodine: A Diagnostic Dilemma

Presentamos 7 casos de dermatitis de contacto por povidona yodada (PVP-I) en pacientes sometidos a cirugía. El diagnóstico se basó en la clínica, la historia de exposición, la localización de las lesiones y el resultado de las pruebas epicutáneas. La dermatitis puede aparecer en el área quirúrgica, pero también en zonas distantes, aunque expuestas a la PVP-I y sometidas a oclusión durante la intervención. Las pruebas epicutáneas con PVP-I al 10% en vaselina fueron positivas en todos los pacientes. Aconsejamos utilizar este vehículo y no agua para el diagnóstico de estas dermatitis de contacto, basados en los resultados de estas pruebas en un grupo control. La prueba abierta repetida con la solución comercial de PVP-I fue negativa. Concluimos en la necesidad de que exista una oclusión, tanto para la aparición de los síntomas clínicos como para el diagnóstico de esta dermatitis de contacto, que puede estar infradiagnosticada

We present 7 cases of postsurgical contact dermatitis due to povidone iodine. The diagnosis was based on the clinical manifestations, the history of exposure, the site of the lesions, and the results of patch tests. This type of dermatitis can develop in the area of surgery or at distant sites exposed to povidone iodine during the surgical intervention. Patch tests with 10% povidone iodine in petrolatum were positive in all patients. Based on the results of the same tests in a control group, we recommend the use of petrolatum rather than water as the vehicle for the diagnosis of this form of contact dermatitis. Repeated open application tests with a commercially available solution of povidone iodine were negative. We conclude that the presence of the solution under occlusion during surgery is necessary both for the symptoms to develop and for the diagnosis to be made. This condition may be underdiagnosed

Effectiveness and safety of iodopovidone in an experimental pleurodesis model

OBJECTIVES: Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model. METHODS: New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed. RESULTS: An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits. CONCLUSION: Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated. .

Disfunción tiroidea yatrogénica en diálisis peritoneal / No disponible

La lista de drogas que pueden causar alteraciones en los niveles de las hormonas tiroideas sería interminable (amiodarona, metformina, dopamina, dobutamina, propanolol, carbamazepina, litio, glucocorticoides….).1,2 Pero también los contrastes radiológicos3 y soluciones que contienen yodo usadas como antiséptico general y desinfectante de amplio espectro como la povidona yodada pueden causar disfunción tiroidea4. Así se sabe que la povidona yodada contenida en los tapones de desconexión de diálisis peritoneal puede ser un factor que contribuya a cambios en la función tiroidea. Si bien, la población de pacientes con mayor riesgo de verse afectada se limita a lactantes y niños en diálisis peritoneal con pequeños volúmenes de llenado, donde la concentración de yodo en el líquido de diálisis es mayor, considerándose infrecuente en población adulta (AU)

To the editor: The list of drugs that may cause changes in thyroid hormone levels would be endless (amiodarone, metformin, dopamine, dobutamine, propranolol, carbamazepine, lithium, glucocorticoids….).1,2 However, radiographic contrast agents3 and iodine-containing solutions used as general antiseptics and broad-spectrum disinfectants, such as povidone iodine, may also cause thyroid dysfunction. 4 Thus, it is known that povidone iodine contained in the disconnect caps of peritoneal dialysis may be a factor contributing to changes in thyroid function.. The patient population with a higher risk is however limited to infants and children on peritoneal dialysis with small filling volumes, where iodine concentration in the dialysis fluid is higher, while thyroid function changes are considered uncommon in the adult population (AU)

Comparaçäo dos triglicerídeos cadeia média com ácidos graxos essenciais, com o polivinilpirrolidona-iodo no tratamento das úlceras de decúbito em pacientes cardiopatas / The use of CTM with essencial fatty acid in decubits ulcers of cardiac patients

Trata-se de um ensaio clínico randomizado em 27 pacientes cardiopatas (clínicos e cirúrgicos) com o objetivo de testar a efetividade do TCM (triglicerídeos de cadéia média) com AGE (ácidos graxos essenciais) como modalidade terapêutica de úlceras de decúbito. O estudo foi efetuado em dois grupos de pacientes cardiopatas utilizando-se para o primeiro grupo soluçäo de TCM com AGE e o segundo grupo PVPI (polivinilpirrolidona-iodo) tópico no tratamento das úlceras. Observou-se que com a soluçäo de TCM com AGE houve uma reduçäo na área total das úlceras de 8 cm2 na primeira semana e com PVPI houve um aumento de 1 cm2 na primeira semana. Da primeira semana à terceira semana a reduçäo da área com TCM com AGE foi de 22,7 cm2 e com PVPI houve um aumento de 7 cm2. Comprovou-se a efetividade da soluçäo de TCM com AGE comparado com a soluçäo convencional que após a sua aplicaçäo aumentou o tamanho da escara.

Toxicidad de la yodo-povidona intraperitoneal: estudio experimental / Toxicity of the intraperitoneal iodo-povidone

Se instiló una solución al 10% de yodo-povidona en la cavidad abdominal de diversas especies de animales. En todas se demostró un efecto letal en breve plazo con dosis entre 10 y 40 cc/kg. Se obtuvo dosis letal-50 en ratones C57-CFW que correspondió a 5 cc/kg. Se concluye que la yodo-povidona por vía intraperitoneal es tóxica y que su uso debe ser limitado a cavidades bloqueadas. Se requerirán más estudios para determinar su utilidad e inocuidad en lavados peritoneales de toda la cavidad (AU)

Toxicidad de la yodo-povidona intraperitoneal: estudio experimental / Toxicity of the intraperitoneal iodo-povidone

Se instiló una solución al 10% de yodo-povidona en la cavidad abdominal de diversas especies de animales. En todas se demostró un efecto letal en breve plazo con dosis entre 10 y 40 cc/kg. Se obtuvo dosis letal-50 en ratones C57-CFW que correspondió a 5 cc/kg. Se concluye que la yodo-povidona por vía intraperitoneal es tóxica y que su uso debe ser limitado a cavidades bloqueadas. Se requerirán más estudios para determinar su utilidad e inocuidad en lavados peritoneales de toda la cavidad