Treatment of Eosinophilic Annular Erythema With Benralizumab.

This case report describes an 83-year-old woman with a generalized pruritic eruption comprising annular and polycyclic plaques on the face, neck, trunk, and extremities with changing appearance.

[Anaphylaxis sugammadex-induced in a pediatric patient]. / Anafilaxia por sugammadex en paciente pediátrico.

INTRODUCTION: Sugammadex is a cyclodextrin that reverses neuromuscular blockade, especially of rocuronium. The occurrence of anaphylaxis produced by its use is of 1:1000 and 1:20000; it is observed mainly in subjects of Asian origin. CASE REPORT: A 9-year-old boy of Asian origin who, after the administration of sugammadex, immediately manifested an episode of anaphylaxis, which was reverted by using adrenaline and antihistamines. The serum tryptase at two hours was 27.7 µg/L; at 6 weeks, it was 3 µ/L. The sugammadex 100 mg/mL skin test was positive. The basophil activation test was positive with sugammadex 20 mg/mL. CONCLUSION: The temporal relationship between the administration of the drug, the clinical manifestations, the elevation of tryptase, and the diagnostic tests performed, disclosed the episode of anaphylaxis associated with hypersensitivity to sugammadex.

Introducción: Sugammadex es una ciclodextrina que revierte el bloqueo neuromuscular, especialmente de rocuronio. La incidencia de anafilaxia producida por su uso es de 1:1.000 y 1:20.000, se observa principalmente en sujetos de origen asiático. Reporte de caso: Niño de 9 años, de raza asiática que tras la administración de sugammadex, inmediatamente manifestó un episodio de anafilaxia, la cual revirtió con el uso de adrenalina y antihistamínicos. La triptasa sérica a las 2 h fue de 27.7 µg/L; a las 6 semanas fue 3 µg/L. La prueba cutánea a sugammadex 100 mg/mL fue positiva. La prueba de activación de basófilos fue positiva con 20 mg/mL sugammadex. Conclusión: La relación temporal de la administración del medicamento, las manifestaciones clínicas, la elevación de la triptasa y las pruebas diagnósticas realizadas, identificaron el episodio de anafilaxia asociado con hipersensibilidad por sugammadex.

Provocation Tests in Nonimmediate Hypersensitivity Reactions to ß-Lactam Antibiotics in Children: Are Extended Challenges Needed?

BACKGROUND: ß-Lactam antibiotics are the most common trigger of reactions in children with most of them being nonimmediate (85.5%), but proven allergy after the allergological workup is between 7% and 10%. There is no agreement on how to perform the provocation tests in these types of hypersensitivity reactions. OBJECTIVE: To determine whether or not repeated doses of the ß-lactams are required to reproduce a nonimmediate reaction in children. METHODS: This is a retrospective observational study. We included children under 14 years who were referred for a nonimmediate reaction to ß-lactams. All patients underwent a 1-day hospital provocation and were kept under observation at home during the following days for at least the time elapsed between the first dose and the symptoms of the index reaction. If no reaction was triggered, the patient resumed the provocation at home with 2 daily therapeutic doses for an equal of interval time. RESULTS: Ninety-seven patients were included in the study. A positive reaction was recorded in 14 of them (14.4%). The short hospital provocation triggered 3 immediate reactions and 8 delayed reactions. The home rechallenge developed 1 immediate reaction and 2 delayed reactions. CONCLUSIONS: Nonimmediate reactions to ß-lactams in children may be triggered with a 1-day provocation test. We suggest to perform a 1-day provocation test followed by an observational period of at least the time interval of the index reaction. If this challenge is negative, an extended home provocation could subsequently be carried out.

Role of dissociation in "false drug allergy".

OBJECTIVE: The aim of the present study was to analyze the influence of dissociation on the "false allergy" phenomenon. METHOD: Fifty-five individuals (11 males and 44 females) who consecutively presented for the study of their suspected drug allergy were assessed. RESULTS: After the challenge test, false allergy was found in 39.3% and placebo positive response in 12.5% of the patients. Seven patients (12.5%) scored above the cut-off point of 20 on the Dissociative Experiences Scale (DES), and 5 out of this group (71.4%) fit in the "false allergy" group. Pathological scores on the DES were associated with the diagnosis of "false allergy" (OR = 9.583, 95% CI = 1.002, 91.621). The effect of age, gender, and other psychopathological variables was controlled. CONCLUSIONS: High levels of dissociation might predispose to false drug allergy, which could complicate pharmacological treatment and therefore increase the patient's complaints and demands for medical attention.