Paramagnetic contrast media: hypersensitivity and cross-reactivity

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Insect Venom Immunotherapy: Analysis of the Safety and Tolerance of 3 Buildup Protocols Frequently Used in Spain.

INTRODUCTION: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. MATERIALS AND METHODS: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. RESULTS: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. CONCLUSIONS: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach.

Insect venom immunotherapy: analysis of the safety and tolerance of 3 buildup protocols frequently used in Spain

Introduction: Hymenoptera venom immunotherapy (VIT) is an effective treatment but not one devoid of risk, as both local and systemic adverse reactions may occur, especially in the initial phases. We compared the tolerance to 3 VIT buildup protocols and analyzed risk factors associated with adverse reactions during this phase. Materials and Methods: We enrolled 165 patients divided into 3 groups based on the buildup protocol used (3, 4, and 9 weeks). The severity of systemic reactions was evaluated according to the World Allergy Organization model. Results were analyzed using exploratory descriptive statistics, and variables were compared using analysis of variance. Results: Adverse reactions were recorded in 53 patients (32%) (43 local and 10 systemic). Local reactions were immediate in 27 patients (63%) and delayed in 16 (37%). The severity of the local reaction was slight/moderate in 15 patients and severe in 13. Systemic reactions were grade 1-2. No significant association was found between the treatment modality and the onset of local or systemic adverse reactions or the type of local reaction. We only found a statistically significant association between severity of the local reaction and female gender. As for the risk factors associated with systemic reactions during the buildup phase, we found no significant differences in values depending on the protocol used or the insect responsible. Conclusions: The buildup protocols compared proved to be safe and did not differ significantly from one another. In the population studied, patients undergoing the 9-week schedule presented no systemic reactions. Therefore, this protocol can be considered the safest approach (AU)

Introducción: La inmunoterapia con veneno de himenópteros (ITV) es un tratamiento eficaz, pero no está desprovisto de riesgo ya que pueden ocurrir reacciones adversas locales o sistémicas, especialmente en las etapas iniciales del tratamiento. Comparamos la tolerancia de tres protocolos de inicio de ITV y analizamos los factores de riesgo asociados con las reacciones adversas que se produjeron en esta fase. Métodos: Se incluyeron 165 pacientes divididos en tres grupos según el protocolo de iniciación utilizado (3, 4 o 9 semanas). Evaluamos la gravedad de las reacciones sistémicas de acuerdo con el modelo de la Organización Mundial de Alergia. Analizamos los resultados mediante estadística descriptiva exploratoria y comparamos variables mediante el análisis de la varianza. Resultados: Cincuenta y tres pacientes (32%) experimentaron algún tipo de reacción adversa; 43 eran locales y 10 sistémicas. Las reacciones locales fueron inmediatas en 27 pacientes (63%) y tardías en 16 (37%). La gravedad de la reacción local fue leve o moderada en 15 pacientes y grave en 13. Las reacciones sistémicas fueron de grado 1 o 2. No encontramos asociación significativa entre la modalidad de tratamiento y la aparición de reacciones adversas locales o sistémicas o el tipo de reacción local. Solo encontramos una asociación estadísticamente significativa de la gravedad de la reacción local con el sexo femenino. En cuanto a los factores de riesgo asociados con las reacciones sistémicas en la fase de inicio, no se encontraron diferencias significativas en estos valores en función del protocolo utilizado o el insecto responsable. Conclusiones: Los protocolos de inicio comparados demostraron ser seguros y no difirieron significativamente entre sí. En la población estudiada, el protocolo de 9-semanas no produjo reacciones sistémicas, por lo que se puede considerar el protocolo más seguro (AU)

Pancreatitis due to codeine.

Pancreatitis is a rare adverse effect of codeine. We report the case of a 42-year-old man who suffered from epigastric pain 1 hour after taking a tablet containing amoxicillin plus clavulanic acid (500/125 mg) and another tablet containing acetaminophen plus codeine (500/30 mg) for a respiratory infection. He was admitted to the emergency room and was treated with metamizol and pantoprazole. A few minutes after receiving intravenous doses of both drugs he developed a maculopapular and itching eruption with facial angioedema. Laboratory tests showed high levels of serum amylase, GOT, GPT and total bilirubin. Serological tests for several viruses showed no evidence of recent infection. Ultrasonography was negative for biliary lithiasis and showed only cholecystectomy performed in 2000. The patient was sent to our department where skin prick and oral challenge tests were performed with negative results. For ethical reasons, oral challenge with codeine was not carried out. We believe that our patient had codeine-induced pancreatitis. The most likely underlying pathophysiological mechanism was probably codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Allergy departments should be aware of possible non-immunological adverse.

Pancreatitis due to codeine

Pancreatitis is a rare adverse effect of codeine. We report the case of a 42-year-old man who suffered from epigastric pain 1 hour after taking a tablet containing amoxicillin plus clavulanic acid (500/125 mg) and another tablet containing acetaminophen plus codeine (500/30 mg) for a respiratory infection. He was admitted to the emergency room and was treated with metamizol and pantoprazole. A few minutes after receiving intravenous doses of both drugs he developed a maculopapular and itching eruption with facial angioedema. Laboratory tests showed high levels of serum amylase, GOT, GPT and total bilirubin. Serological tests for several viruses showed no evidence of recent infection. Ultrasonography was negative for biliary lithiasis and showed only cholecystectomy performed in 2000. The patient was sent to our department where skin prick and oral challenge tests were performed with negative results. For ethical reasons, oral challenge with codeine was not carried out. We believe that our patient had codeine-induced pancreatitis. The most likely underlying pathophysiological mechanism was probably codeine-induced spasm of the sphincter of Oddi combined with sphincter of Oddi dysfunction related to a previous cholecystectomy. Allergy departments should be aware of possible non-immunological adverse

La pancreatitis es un efecto secundario raramente producido por la codeína. Presentamos el caso de un paciente de 42 años que sufrió dolor epigástrico, una hora después de la ingesta de un comprimido de amoxicilina-clavulánico (500/125 mg) y otro de paracetamol-codeína (500/30 mg) por un cuadro infeccioso de vías altas. Acude al servicio de urgencias donde es tratado con metamizol y pantoprazol por vía intravenosa, presentando unos minutos después de su infusión, una erupción máculo-papulosa muy pruriginosa acompañada de angioedema facial. Las pruebas de laboratorio mostraron niveles elevados de amilasa sérica, GOT, GPT y bilirrubina total. Las pruebas serológicas de distintos virus no mostraron evidencia de infección reciente. El estudio ecográfico fue negativo para litiasis biliar y solamente mostró la existencia de una colecistectomía realizada en el año 2000. Fue derivado a nuestra sección donde se le hicieron pruebas cutáneas y de provocación con resultado negativo con los fármacos implicados, excepto con codeína por razones éticas. Pensamos que la codeína fue la responsable del cuadro de pancreatitis sufrido por el paciente y el probable mecanismo patofisiológico subyacente habría sido el espasmo del esfínter de Oddi inducido por la codeína, combinado con una disfunción relacionada con la colecistectomía previa. Por tanto, los servicios de Alergia deben considerar la posible existencia de reacciones adversas de etiología no inmunológica, que pueden originar patologías graves a los pacientes

Reacciones adversas producidas por vacunas infantiles / Adverse reactions to childhood vaccines

Las vacunas han cambiado la vida de millones de personas en el mundo. Enfermedades como la viruela han sido erradicadas, la poliomielitis está en camino de serlo y otras han disminuido drásticamente. La inmunización activa consiste en estimular al organismo para producir anticuerpos, mediante la administración de una vacuna, lo que origina una respuesta similar a la infección natural pero sin riesgo para el vacunado. Este artículo examina las reacciones adversas producidas tras la vacunación y en especial las reacciones de hipersensibilidad. La incidencia de algunas de ellas se aproxima a 1:100.000 sujetos vacunados. Estas reacciones por vacunas se pueden clasificar atendiendo a la causa que las induce en: reacciones debidas a la propia vacuna, idiosincrásicas, asociadas a errores de manipulación, almacenaje o administración y reacciones coincidentes con la vacunación. Como las vacunas consisten en una mezcla del microorganismo activo, antibióticos, conservantes, proteínas del medio de cultivo y aditivos, es fácil adivinar que tras la vacunación se pueden producir reacciones de hipersensibilidad. Las vacunas incluidas en el programa de vacunación son extraordinariamente seguras y eficaces. Por tanto, los niños que presenten alguna reacción adversa al recibir las vacunas, que normalmente son combinadas, deben someterse a un estudio antes de interrumpir su calendario de vacunación, ya que los efectos adversos que producen se presentan con una frecuencia muy baja. Las nuevas técnicas de biología y genética molecular abren un campo nuevo para la elaboración de vacunas. Las áreas más prometedoras son: la tecnología del ADN recombinante, la expresión controlada de genes y la síntesis de péptidos. Estas técnicas crearán vacunas nuevas y más seguras, lo que reducirá las reacciones adversas

Use of vaccines has altered life for millions of world´s citizens. Smallpox has been eradicated. Poliomyelitis is on the way to potential eradication and other childhood diseases have been dramatically reduced. Vaccination is an attempt to replace the natural primary contact with a safer artificial contact so that natural contact first takes place in the face of heightened immunity. This report examines adverse reactions to vaccines after immunization, specially hypersensitivity reactions. The incidence of some reactions may approximate 1:100.000 individual vaccinated. These reactions can be classified according to probable cause as vaccination-induced reactions (due to an effect of the vaccine itself or an idiosyncrasia), reactions associated with faulty production, storage or administration and coincidental reactions Because vaccines consist of mixture of the active agent, antibiotics, preservatives, culture medium proteins and other additives, it is not surprising that hypersensitivity reactions occur after vaccination. Vaccines currently used for routine preventive care in children are extraordinarily safe and effective. So children should not be excluded from the normal vaccine schedule when they suffer from a reaction after receipt of such a combination. So that a logical analysis has been performed due to adverse reactions occur at a very low frequency. It seems likely that advances in vaccines will occur through the application of molecular biology and, in particular, molecular genetics. The three most promising areas are recombinant DNA technology, controlled gene expression and synthetic peptide chemistry. These techniques will create new and safer vaccines and will reduce the possibility of adverse reactions to vaccines