Clinical Practice Guidelines for Diagnosis and Management of Hypersensitivity Reactions to Contrast Media.

The objective of these guidelines is to ensure efficient and effective clinical practice. The panel of experts who produced this consensus document developed a research protocol based on a review of the literature. The prevalence of allergic reactions to iodinated contrast media (ICM) is estimated to be 1:170 000, that is, 0.05%-0.1% of patients undergoing radiologic studies with ICM (more than 75 million examinations per year worldwide). Hypersensitivity reactions can appear within the first hour after administration (immediate reactions) or from more than 1 hour to several days after administration (nonimmediate or delayed reactions). The risk factors for immediate reactions include poorly controlled bronchial asthma, concomitant medication (eg, angiotensin-converting enzyme inhibitors, ß-blockers, and proton-pump inhibitors), rapid administration of the ICM, mastocytosis, autoimmune diseases, and viral infections. The most common symptoms of immediate reactions are erythema and urticaria with or without angioedema, which appear in more than 70% of patients. Maculopapular rash is the most common skin feature of nonimmediate reactions (30%-90%). Skin and in vitro tests should be performed for diagnosis of both immediate and nonimmediate reactions. The ICM to be administered will therefore be chosen depending on the results of these tests, the ICM that induced the reaction (when known), the severity of the reaction, the availability of alternative ICM, and the information available on potential ICM cross-reactivity. Another type of contrast media, gadolinium derivatives, is used used for magnetic resonance imaging. Although rare, IgE-mediated reactions to gadolinium derivatives have been reported.

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.

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