Assuntos
Anafilaxia/etiologia , Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , SARS-CoV-2/imunologia , Vacinas Sintéticas/efeitos adversos , Vacina de mRNA-1273 contra 2019-nCoV , Adulto , Idoso , Anafilaxia/diagnóstico , Vacina BNT162 , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos , Inquéritos e Questionários , Vacinas de mRNAAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Anafilaxia/etiologia , Infecções por Coronavirus/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/imunologia , Vacinas Sintéticas/efeitos adversos , Anafilaxia/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Testes Cutâneos , Inquéritos e QuestionáriosAssuntos
Acetato de Abiraterona/uso terapêutico , Alérgenos/efeitos adversos , Antineoplásicos/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Neoplasias da Próstata/tratamento farmacológico , Acetato de Abiraterona/efeitos adversos , Administração Oral , Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/prevenção & controle , Exantema , Humanos , Hipersensibilidade Tardia , Imunização , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Náusea , Neoplasias da Próstata/complicações , VômitoAssuntos
Pustulose Exantematosa Aguda Generalizada/diagnóstico , Antibacterianos/efeitos adversos , Artroplastia do Joelho , Hipersensibilidade a Drogas/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Pele/patologia , Teicoplanina/efeitos adversos , Pustulose Exantematosa Aguda Generalizada/etiologia , Alérgenos/imunologia , Antibacterianos/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Testes do Emplastro , Teicoplanina/imunologia , Teicoplanina/uso terapêuticoRESUMO
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.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Fígado/metabolismo , Pele/patologia , Algoritmos , Alopurinol/efeitos adversos , Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Comorbidade , Consenso , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Eosinofilia , Prova Pericial , Humanos , Leucocitose , Fígado/patologia , Fatores de Risco , Espanha/epidemiologiaRESUMO
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.
Assuntos
Anestésicos Gerais/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/efeitos adversos , Anestésicos Intravenosos/efeitos adversos , Atracúrio/efeitos adversos , Atracúrio/análogos & derivados , Feminino , Fentanila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueadores Neuromusculares/efeitos adversos , Período Perioperatório , Valor Preditivo dos Testes , Propofol/efeitos adversos , Remifentanil/efeitos adversos , Rocurônio/efeitos adversos , Testes Cutâneos , Sugammadex/efeitos adversos , Adulto JovemRESUMO
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
Assuntos
Humanos , Síndrome de Hipersensibilidade a Medicamentos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/prevenção & controle , Síndrome de Hipersensibilidade a Medicamentos/terapia , EspanhaRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hipersensibilidade a Drogas/epidemiologia , Heparina/efeitos adversos , Heparina de Baixo Peso Molecular/efeitos adversos , Anticoagulantes/efeitos adversos , Testes Intradérmicos/estatística & dados numéricos , Reações Cruzadas/imunologia , Valor Preditivo dos Testes , Tromboembolia/prevenção & controleAssuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Toxidermias/diagnóstico , Exantema/diagnóstico , Piridinas/efeitos adversos , Sulfonas/efeitos adversos , Artralgia/tratamento farmacológico , Artralgia/patologia , Toxidermias/etiologia , Toxidermias/imunologia , Toxidermias/patologia , Etoricoxib , Exantema/induzido quimicamente , Exantema/imunologia , Exantema/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Osteoartrite/tratamento farmacológico , Osteoartrite/patologia , Testes do EmplastroRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Exantema/complicações , Exantema/imunologia , Axila/lesões , Axila/fisiopatologia , Ibuprofeno/uso terapêutico , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/imunologia , Aspartato Aminotransferases/uso terapêutico , Alanina Transaminase/uso terapêutico , Metilprednisolona/uso terapêutico , Anti-Inflamatórios não Esteroides/uso terapêutico , Hipersensibilidade/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Masculino , Urticária/complicações , Urticária/diagnóstico , Cannabis/efeitos adversos , Cannabis/toxicidade , Lipídeos/administração & dosagem , Rinite Alérgica Sazonal/diagnóstico , Testes Cutâneos/métodos , Urticária/metabolismo , Urticária/prevenção & controle , Cannabis/classificação , Cannabis/metabolismo , Lipídeos , Rinite Alérgica Sazonal/metabolismo , Testes Cutâneos/instrumentaçãoRESUMO
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.