Fatal Anaphylactic Shock Ceftriaxone-Induced in a 4-Year-Old Child.

One of the most used cephalosporin in clinical practice is ceftriaxone. Anaphylaxis due to the administration of ceftriaxone is considered a rare event. Here, we report a case of fatal anaphylactic shock after the administration of ceftriaxone in a child who had tolerated the drug in past exposures. The allergic pathogenesis is sustained by the clinical data (short time between the inoculation of the drug and the onset of the symptoms; past exposure to the same molecule and probable sensitization) and the postmortem examination findings (polivisceral congestion and intense eosinophilia found in the histological examination).

Increased levels of interleukin 31 (IL-31) in osteoporosis.

BACKGROUND: Several inflammatory cytokines play a key part in the induction of osteoporosis. Until now, involvement of the Th2 cytokine interleukin-31 (IL-31) in osteoporosis hadn't yet been studied. IL-31 is a proinflammatory cytokine mediating multiple immune functions, whose involvement in a wide range of diseases, such as atopic dermatitis, inflammatory bowel diseases and cutaneous lymphomas, is now emerging. Given the important role of IL-31 in inflammation, we measured its serum levels in postmenopausal osteoporotic patients. METHODS AND RESULTS: In fifty-six postmenopausal females with osteoporosis and 26 healthy controls, bone mineral density (BMD) measurements were performed by using calcaneal quantitative ultrasound (QUS) technique, confirmed at the lumbar spine and hip by dual energy X-ray absorptiometry (DXA). Both patients and controls were divided according to age (less or more than 65 years) and disease severity (T-score levels and presence of fractures). Serum IL-31 levels were measured by ELISA technique. Osteoporotic patients exhibited elevated levels of serum IL-31 compared with healthy controls (43.12 ± 6.97 vs 29.58 ± 6.09 pg/ml; p < 0.049). IL-31 expression was higher in over 65 years old patients compared to age-matched controls (45 ± 11.05 vs. 17.92 ± 5.92; p < 0.01), whereas in younger subjects no statistically significant differences were detected between patients and controls (37.91 ± 6.9 vs 32.08 ± 8.2). No statistically significant differences were found between IL-31 levels in patients affected by mild (T-score > -3) compared to severe (T-score < -3) osteoporosis (59.17 ± 9.22 vs 37.91 ± 10.52), neither between fractured and unfractured osteoporotic women (33.75 ± 9.16 vs 51.25 ± 8.9). CONCLUSIONS: We showed for the first time an increase of IL-31 serum levels in postmenopausal women with decreased BMD. Although they did not reflect the severity of osteoporosis and/or the presence of fractures, they clearly correlated with age, as reflected by the higher levels of this cytokine in aged patients.

Increased serum levels of interleukin-23 circulating in patients with non-segmental generalized vitiligo.

INTRODUCTION: Vitiligo is a common progressive depigmentation of the skin due to selective destruction of melanocytes. Nowadays increasing evidences support the hypothesis of an autoimmune etiology. METHODS: In order to sustain the role of T-helper-17 lymphocytes in the pathogenesis of vitiligo, we measured the serum levels of interleukin (IL)-23 (an important regulator of this subset) using a quantitative enzyme immunoassay technique in 12 males and 16 females (ages ranging from 18 to 58 years) affected by non-segmental vitiligo and compared the results with a group of healthy donors. RESULTS: IL-23 serum levels were significantly higher in patients with vitiligo as compared with controls. There was a significant positive correlation of IL-23 serum levels with disease duration and extent of vitiligo and disease activity. CONCLUSIONS: The inhibition of IL-23 might be a novel strategy in the therapy of autoimmune inflammatory diseases like vitiligo.

Oxidative stress in oncohematologic diseases: an update.

An increased risk of cancer in various organs has been related to oxidative stress and several studies have revealed the mechanism by which continued oxidative stress can lead to chronic inflammation, which in turn could mediate most chronic diseases including cancer. A variety of transcription factors may be activated in consequence of oxidative stress, leading to the expression of over 500 different genes, including those for growth factors, inflammatory cytokines, chemokines, cell cycle regulatory molecules and anti-inflammatory molecules. In this review, the data related to the action of oxidative stress on the onset of various oncohematologic diseases are summarized, thus bringing together some of the latest information available on the pathogenetic role of oxidative stress in cancer. The authors evaluate the most recent publications on this topic, and, in particular, show the newest evidence of a relationship between oxidative stress and hematological malignancies, such as chronic lymphocytic leukemia, Hodgkin's lymphoma, multiple myeloma and chronic Ph-negative myeloproliferative diseases. A separate section is devoted to the implications of a change of oxidative stress in patients undergoing bone marrow transplantation. Finally, particular attention is given to the new markers of oxidative stress, such as carbonyl groups, advanced glycation end products, advanced oxidation protein products and S-nitrosylated proteins, which are certainly more stable, reliable, cheaper and more easily identifiable than those already used in clinical practice. New approaches that aim to evaluate subcellular and microenvironment redox potential may be useful in developing cancer diagnostics and therapeutics.

Hypersensitivity to tranexamic acid: a wide spectrum of adverse reactions.

CASES DESCRIPTION: This is a retrospective study, based on analysis of data from patients with previous adverse drug reactions admitted to the Allergy and Clinical Immunology Division of both the University of Messina and the University of Bari in the last 4 years. We observed five patients: four of them (two males and two females) with a well documented history of tranexamic acid hypersensitivity reactions and one female who showed a positive response to an intradermal challenge test with tranexamic acid. CONCLUSIONS: Although the risk of immunogenic and severe allergic reactions to tranexamic acid is significantly lower than those associated with administration of other drugs, our experience points out that adverse reactions to tranexamic acid can occur. This drug may be responsible for a wide and various spectrum of hypersensitivity reactions characterized by different pathogenetic mechanisms (immunologic and non-immunologic). Etamsylate was a well tolerated alternative drug to tranexamic acid in all examined patients.

Possible link between history of hypersensitivity to a specific non-steroidal anti-inflammatory drug (NSAID) and positive results following challenge test to alternative NSAIDS.

INTRODUCTION: In subjects with hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs), the choice of suitable alternative drugs with the lowest risk of reaction is imperative for therapeutic management. A safe method to exclude drug hypersensitivity is to perform a challenge test for an alternative drug. The present study was conducted to: obtain more information about the safety of NSAIDs; assess the risk of reaction following the administration of a selective or nonselective cyclooxygenase 2 (COX-2) inhibitor in patients with a history of adverse reactions to NSAIDs; investigate if age and/or gender play a role in the susceptibility to develop adverse reactions to NSAIDs. PATIENTS AND METHODS: This retrospective study includes 524 patients with a history of hypersensitivity to NSAIDs admitted to undergo challenge test to an alternative anti-inflammatory drug. Statistical significance was achieved when odds ratio (OR) and risk ratio (RR) values were >1. RESULTS: 8.39% of patients with hypersensitivity reactions to NSAIDs showed a positive challenge test for the alternative drug. Challenge tests for nonselective COX-2 inhibitors were positive in 16.2% of patients with previous reaction to a same drug class and in 12.9% of patients with a history of reaction to selective COX-2 inhibitors. No positive challenge test to a non-selective COX-2 inhibitor was found in patients with a history of hypersensitivity to nimesulide (CAS 51803-78-2). Challenge tests for selective COX-2 inhibitors were positive in 4.6% of patients with a previous reaction to nonselective COX-2 inhibitors and in 7.2% of patients with a history of reaction to selective COX-2 inhibitors. The RR of a positive challenge test to a non-selective COX-2 inhibitor was significant in patients who had a history of reaction to an analogous compound (P 0.21, OR 1.31, RR 1.26). DISCUSSION: In this study, selective COX-2 inhibitors represented the class of NSAIDs less frequently reported as responsible of adverse reaction. These data underline that there is a higher risk to find a positive challenge test to a non-selective COX-2 inhibitor than to a selective one in patients with previous adverse reactions to a non-selective COX-2 inhibitor. Moreover, the data evidence that females could have a higher risk compared to males to develop an adverse reaction to selective COX-2 inhibitors. In conclusion, it appears necessary to pay attention to the kind of NSAIDs reported as the cause of hypersensitivity in anamnesis, because it must be considered a successful guide in choosing the alternative drug to administer to the patient during the challenge test.