Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.578
Filtrar
1.
Chem Biol Interact ; 330: 109248, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32871113

RESUMO

Dextromethorphan (DM) is a cough suppressant available in many prescribed and over-the-counter medications. Adverse reactions induced by DM have been regularly reported, including allergic skin reactions in some cases. However, the underlying mechanisms of local anaphylaxis induced by DM have not been elucidated. In this study, we found that DM could activate mast cells to increase calcium mobilization and release ß-hexosaminidase, histamine, tumor necrosis factor-α, MCP-1, and IL-8 in a dose-dependent manner. The allergic reactions were confirmed by hind paw swelling and extravasation assay in vivo. Furthermore, DM was revealed to induce local anaphylaxis via MRGPRX2 by the mast cell-deficient kitW-sh/W-sh mice and MRGPRX2 knockdown mast cells. And the MRGPRX2-HEK293/CMC analysis and frontal analysis also showed that DM has a considerable affinity with MRGPRX2. Together, our findings suggest that close monitoring should be drawn on patients with DM for its potential anaphylaxis via MRGPRX2.


Assuntos
Anafilaxia/induzido quimicamente , Dextrometorfano/efeitos adversos , Mastócitos/efeitos dos fármacos , Receptores Acoplados a Proteínas-G/metabolismo , Animais , Antitussígenos/efeitos adversos , Células Cultivadas , Dextrometorfano/toxicidade , Técnicas de Silenciamento de Genes , Células HEK293 , Humanos , Mastócitos/imunologia , Mastócitos/metabolismo , Camundongos , Camundongos Knockout , Proteínas do Tecido Nervoso/metabolismo , Receptores de Neuropeptídeos/metabolismo
3.
PLoS One ; 15(6): e0235076, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584876

RESUMO

Due to the complexity and fragility of biological drug products, several challenges exist in their formulation development. Excipients are added to increase product stability, maintain tonicity, and facilitate drug delivery. The potential implications of these additive substances merit clinical consideration. We assessed the safety risk of excipients on the basis of their type and variability through an assessment framework, which quantifies excipient complexity in 230 biological formulations, and identifies excipient-related adverse events through published case reports. A biologic on average contained 4.45 excipients, half of that found in oral medications. The frequency distribution was heavily skewed towards the most commonly occurring excipients: water (40.4%), sodium chloride (38.3%), polysorbate 80 (28.7%), sucrose (24.4%), and mannitol (20.9%), with 44.4% of formulations not listing the concentration of the most commonly occurring inactive ingredients. A literature search revealed only 17 case reports of excipient-related adverse events, suggesting the need for more clarity for clinicians on the safety of chemical additives. These cases included injection site reactions, anaphylaxis, hyperglycemia, and acute renal failure. With the expansion of the biopharmaceutical market, it is important to consider the safety data of biologic excipients, so that therapy can be tailored appropriately for a specific patient.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Anafilaxia/induzido quimicamente , Excipientes/efeitos adversos , Hiperglicemia/induzido quimicamente , Química Farmacêutica , Excipientes/uso terapêutico , Humanos , Manitol/efeitos adversos , Manitol/uso terapêutico , Polissorbatos/efeitos adversos , Polissorbatos/uso terapêutico , Cloreto de Sódio/efeitos adversos , Cloreto de Sódio/uso terapêutico , Sacarose/efeitos adversos , Sacarose/uso terapêutico , Água/efeitos adversos
4.
Curr Opin Anaesthesiol ; 33(3): 448-453, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32371637

RESUMO

PURPOSE OF REVIEW: Perioperative hypersensitivity reactions can pose diagnostic and management challenges for the anaesthetist. Difficulties in diagnosing hypersensitivity reactions in the perioperative setting are highlighted and recommendations from recent guidelines on the acute management of life-threatening anaphylaxis are presented. RECENT FINDINGS: Anaesthetists play a key role in investigating perioperative hypersensitivity reactions. During a suspected perioperative hypersensitivity event, a serum tryptase level should be measured to help with subsequent allergy investigation. Moreover, anaesthetists can ensure that a high-quality referral is made to allergy clinics by providing thorough documentation of the events, detailing symptoms, treatments, and the chronology of drug administrations. SUMMARY: Perioperative hypersensitivity reactions are rare but can be life-threatening. A high index of suspicion should be maintained for their successful management. Whenever a perioperative hypersensitivity reaction is suspected, close collaboration between anaesthetist and the allergy team investigating the patient is paramount, in order for the patient to be appropriately investigated and have an uneventful anaesthetic in the future.


Assuntos
Anafilaxia/induzido quimicamente , Anestésicos/efeitos adversos , Anestesistas/psicologia , Hipersensibilidade a Drogas , Hipnóticos e Sedativos/efeitos adversos , Cuidados Pré-Operatórios , Humanos , Período Perioperatório , Fatores de Risco
6.
Arerugi ; 69(1): 48-52, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32051369

RESUMO

BACKGROUND: Cochineal dyes are used as additives in various foods for the purpose of red coloration. On the other hand, although it has been reported as a causative agent of immediate allergy, most of them are adult women. We report a case of an 8-year-old boy who developed a cochineal allergy.Current disease history: He has been suffering from atopic dermatitis, bronchial asthma, and food allergies since childhood. At the age of seven, he experienced an unknown anaphylaxis reaction twice. When he was 8 years old, he ate a frankfurter containing hypoallergenic cochineal for the first time; cold sweat, intraoral discomfort, respiratory distress, and urticaria appeared throughout the body. His skin prick tests were positive, with a result of 2+to frankfurter and cochineal dyes (color value 0.1 and 0.01). In the immunoblot assay, binding of IgE antibody was observed with CC38K (the main component of cochineal) and a protein of approximately 80-200 kDa in the high molecular weight region. DISCUSSION: We report a case of anaphylaxis with hypoallergenic cochineal onset in a school-age boy.


Assuntos
Anafilaxia/induzido quimicamente , Carmim/efeitos adversos , Hipersensibilidade Alimentar , Urticária/induzido quimicamente , Criança , Feminino , Humanos , Masculino , Testes Cutâneos
8.
Phytomedicine ; 68: 153149, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32032836

RESUMO

BACKGROUND: Mast cells (MCs) are crucial effectors in allergic disorders by secreting inflammatory mediators. The Mas-related G-protein-coupled receptor X2 (Mrgprx2) was shown to have a key role in IgE-independent allergic reactions. Therefore, potential drug candidates that directly target Mrgprx2 could be used to treat pseudo-allergic diseases. Shikonin, an active ingredient derived from Lithospermum erythrorhizon Sieb. et Zucc has been used for its anti-inflammatory properties since ancient China. PURPOSE: To investigate the inhibitory effects of Shikonin on IgE-independent allergy both in vitro and in vivo, as well as the mechanism underlying its effects. METHODS/STUDY DESIGNS: The anti-anaphylactoid activity of Shikonin was evaluated in PCA and systemic anaphylaxis models, Calcium imaging was used to assess intracellular Ca2+ mobilization. The release of cytokines and chemokines was measured using enzyme immunoassay kits. Western blot analysis was conducted to investigate the molecules of PLCγ-PKC-IP3 signaling pathway. The analytical method of surface plasmon resonance was employed to study the interaction between Shikonin and potential target protein Mrgprx2. RESULTS: Shikonin can suppress compound 48/80 (C48/80)-induced PCA, active systemic anaphylaxis, and MCs degranulation in mice in a dose-dependent manner. In addition, Shikonin reduced C48/80-induced calcium flux and suppressed LAD2 cell degranulation via PLCγ-PKC-IP3 signaling pathway. Moreover, Shikonin was found to inhibit C48/80-induced Mrgprx2 expression in HEK cells, displaying specific interactions with the Mrgprx2 protein. CONCLUSION: Shikonin could be a potential antagonist of Mrgprx2, thereby inhibiting pseudo-allergic reactions through Ca2+ mobilization.


Assuntos
Anafilaxia/tratamento farmacológico , Hipersensibilidade/tratamento farmacológico , Naftoquinonas/farmacologia , Proteínas do Tecido Nervoso/imunologia , Receptores Acoplados a Proteínas-G/imunologia , Receptores de Neuropeptídeos/imunologia , Anafilaxia/induzido quimicamente , Animais , Cálcio/metabolismo , Degranulação Celular/efeitos dos fármacos , Linhagem Celular , Quimiocinas/metabolismo , Citocinas/metabolismo , Humanos , Hipersensibilidade/imunologia , Masculino , Mastócitos/efeitos dos fármacos , Mastócitos/metabolismo , Camundongos Endogâmicos C57BL , Naftoquinonas/química , Proteínas do Tecido Nervoso/antagonistas & inibidores , Proteínas do Tecido Nervoso/química , Proteínas do Tecido Nervoso/metabolismo , Fosfolipase C gama/metabolismo , Receptores Acoplados a Proteínas-G/antagonistas & inibidores , Receptores Acoplados a Proteínas-G/química , Receptores Acoplados a Proteínas-G/metabolismo , Receptores de Neuropeptídeos/antagonistas & inibidores , Receptores de Neuropeptídeos/química , Receptores de Neuropeptídeos/metabolismo , Secretagogos/toxicidade , p-Metoxi-N-metilfenetilamina/toxicidade
10.
Curr Allergy Asthma Rep ; 20(1): 4, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31993777

RESUMO

PURPOSE OF REVIEW: Progestogen hypersensitivity (PH) is a condition which typically occurs in women in childbearing years with a spectrum of symptoms ranging from urticaria with or without angioedema, dermatitis to systemic anaphylaxis. Herein, a clinical case of PH is presented followed by a discussion on the evaluation, diagnosis, and management of PH. RECENT FINDINGS: Progestogen hypersensitivity (a.k.a. "autoimmune progesterone dermatitis") symptoms are associated with exogenous progestin exposure (e.g., contraceptive medicines, in vitro fertilization therapy) or endogenous progesterone from progesterone surges during the luteal phase of the menstrual cycle and pregnancy. This condition can be difficult to recognize due to its heterogeneous clinical presentation. The mechanism of PH is believed to be primarily IgE-mediated; however, less commonly other immune responses may be involved. There is now a useful progesterone specific IgE immunoassay to assist in diagnosis and well-defined treatment algorithms that can be used to successfully manage PH. The epidemiology of PH is still poorly elucidated but is likely to be encountered by clinicians and especially allergists given the extensive use of oral contraceptives and increased use of supra-physiologic doses of progesterone required to support pregnancy in IVF. Including PH in the differential diagnosis of women presenting with cyclic hypersensitivity will accelerate diagnosis and successful management of this condition.


Assuntos
Anafilaxia/induzido quimicamente , Doenças Autoimunes/induzido quimicamente , Dispositivos Intrauterinos Medicados/efeitos adversos , Progesterona/efeitos adversos , Progestinas/efeitos adversos , Urticária/induzido quimicamente , Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Antialérgicos/uso terapêutico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/tratamento farmacológico , Dermatite/diagnóstico , Dermatite/tratamento farmacológico , Dessensibilização Imunológica , Remoção de Dispositivo , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina E/sangue , Omalizumab/uso terapêutico , Urticária/diagnóstico , Urticária/tratamento farmacológico , Adulto Jovem
12.
Trop Doct ; 50(3): 238-239, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31902297

RESUMO

A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.


Assuntos
Anafilaxia/induzido quimicamente , Antivenenos/uso terapêutico , Brometo de Piridostigmina/uso terapêutico , Mordeduras de Serpentes/tratamento farmacológico , Venenos de Serpentes/antagonistas & inibidores , Adulto , Antivenenos/efeitos adversos , Feminino , Humanos , Paralisia/tratamento farmacológico , Paralisia/fisiopatologia , Recuperação de Função Fisiológica/efeitos dos fármacos , Mordeduras de Serpentes/fisiopatologia
13.
Br J Anaesth ; 124(2): 154-163, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791621

RESUMO

BACKGROUND: Although cases of anaphylaxis caused by sugammadex have been reported, its incidence remains uncertain. Conversely, no studies have evaluated the incidence of anaphylaxis to neostigmine. METHODS: This was a retrospective multicentre observational study of patients who underwent surgery under general anaesthesia between 2012 and 2016 to compare the incidence of anaphylaxis with sugammadex with that of neostigmine at four tertiary hospitals in Japan. To ensure the quality of diagnosis, only cases with a clinical history suggestive of anaphylaxis, along with positive results from in vitro or in vivo testing, were assessed. RESULTS: From a total of 49 532 patients who received general anaesthesia included in this study, 18 cases of anaphylaxis were reported, of which six were attributable to sugammadex and none to neostigmine. There were no fatalities attributable to anaphylaxis. The incidence of anaphylaxis caused by all drugs or by sugammadex was calculated as 0.036% (95% confidence interval [CI]: 0.022-0.057%) and 0.02% (of the number of sugammadex cases) (95% CI: 0.007-0.044%), respectively. CONCLUSIONS: The results suggest that neostigmine might be safer than sugammadex when assessing only the incidence of anaphylaxis. We believe that there is room for reconsideration of the choice of reversal agent for neuromuscular blocking agents by all anaesthetists. CLINICAL TRIAL REGISTRATION: UMIN000022365; UMIN000033561.


Assuntos
Anafilaxia/induzido quimicamente , Inibidores da Colinesterase/efeitos adversos , Neostigmina/efeitos adversos , Sugammadex/efeitos adversos , Adolescente , Adulto , Idoso , Feminino , Humanos , Incidência , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Indian J Pharmacol ; 51(5): 350-351, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31831926

RESUMO

Among the immune-mediated reactions, anaphylaxis is the most severe form. As a postoperative analgesia, diclofenac sodium, and nonsteroidal anti-inflammatory drug is commonly used. Intravenous (IV) diclofenac sodium-induced anaphylaxis is very rare. We are presenting a case of IV diclofenac-induced anaphylactic reaction, occurred during the surgery in a female patient of 21 years of age. The sign and symptoms of the reaction resembled an anaphylactic reaction. Temporal relationship with IV diclofenac administration and development of the clinical features of the reaction found to be probable. The health-care professionals should be aware of such rare and serious reactions so that it can be diagnosed and treated early. The clinical importance associated with the case encouraged us to report this rare complication of IV diclofenac.


Assuntos
Anafilaxia/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Diclofenaco/efeitos adversos , Administração Intravenosa , Anafilaxia/diagnóstico , Anti-Inflamatórios não Esteroides/administração & dosagem , Diclofenaco/administração & dosagem , Feminino , Humanos , Adulto Jovem
17.
Medicine (Baltimore) ; 98(50): e18369, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852144

RESUMO

RATIONALE: Anaphylaxis is a serious allergic reaction which could be life-threatening. To date, it could be diagnosed by causality between clinical manifestations and triggers. But it is not always easy to find out the clue. Chlorpheniramine maleate (peniramin) is known to safe and it is an antihistamine commonly used to treat almost the whole allergic disease, including urticaria and allergic rhinitis. We recently experienced 2 cases of chlorpheniramine induced anaphylaxis. To document suspected cases of chlorpheniramine-induced adverse reactions, we analyzed a database spontaneously reported adverse drug reactions in the Ajou Regional Pharmacovigilance Center from 2011 to 2017. PATIENT CONCERNS: Two female patients presented urticaria and abdominal pain right after chlorpheniramine injection. DIAGNOSES: Both patients were diagnosed with symptoms. One patient confirmed by assistance with tryptase level and another one confirmed cross-reactivity by skin tests. INTERVENTIONS: One patient was instructed to avoid future administration of chlorpheniramine. The other patient was advised not to take chlorpheniramine, and piperazine derivatives including cetirizine/levocetirizine, but piperidine derivatives such as fexofenadine, loratadine, and ebastine can be available. OUTCOMES: The patients fully recovered after prompt treatment for anaphylaxis. After that, no recurrences were observed at the following. Among 54 patients with chlorpheniramine-induced adverse drug reactions from the Pharmacovigilance Center database, 17 (31.5%) were reported as anaphylaxis. LESSONS: Physicians should be aware chlorpheniramine could be a cause for allergic reaction. In addition, we suggest that serum tryptase level, skin prick test, and intradermal test could be considered as a supplementary test for diagnosing chlorpheniramine anaphylaxis and cross-reactivity should also be considered.


Assuntos
Anafilaxia/induzido quimicamente , Clorfeniramina/efeitos adversos , Antagonistas dos Receptores Histamínicos H1/efeitos adversos , Bases de Dados de Produtos Farmacêuticos , Feminino , Humanos , Pessoa de Meia-Idade , Farmacovigilância , República da Coreia , Triptases/sangue , Urticária/induzido quimicamente
18.
BMC Ophthalmol ; 19(1): 261, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856768

RESUMO

BACKGROUND: Fluorescein angiography is an important and frequently used diagnostic tool in ophthalmological practice. In this case report we describe a patient who experienced an anaphylactic reaction after the injection of fluorescein. Furthermore, we report an interference with laboratory testing by fluorescein in this patient and summarize the literature on this topic. CASE PRESENTATION: An 86-year old Caucasian woman undergoing fluorescein angiography due to suspected peripapillary neovascularizations collapsed after the injection of fluorescein. The patient developed an anaphylactic reaction. With fluid resuscitation and oxygen therapy, the patient regained consciousness after a few minutes. The patient was admitted to the geriatric ward for observation, and routine blood and urine tests were performed. Urine protein concentration appeared to be falsely increased as a consequence of disturbance of the laboratory analysis by the presence of fluorescein. CONCLUSIONS: Serious complications can occur with fluorescein angiography, such as an anaphylactic reaction. In the case of anaphylaxis appropriate supportive measures including the use of oxygen and epinephrine (e.g. EpiPen), should be available to prevent morbidity and mortality from this test. Furthermore, these potential complications should be taken into consideration when choosing the healthcare setting for fluorescein angiography, such as the immediate availability of an acute medical team. Several studies have demonstrated the interference of laboratory analyses by fluorescein. The majority of these studies were published 10 to 30 years ago. By presenting this case, the authors hope to bring renewed attention to this phenomenon among clinicians, as falsely increased or decreased laboratory values can result in unnecessary diagnostics and/or therapy.


Assuntos
Anafilaxia/induzido quimicamente , Angiofluoresceinografia , Fluoresceína/efeitos adversos , Proteinúria/urina , Idoso de 80 Anos ou mais , Anafilaxia/diagnóstico , Anafilaxia/terapia , Técnicas de Laboratório Clínico , Feminino , Hidratação , Humanos , Injeções Intravenosas , Oxigenoterapia , Neovascularização Retiniana/diagnóstico , Urinálise
19.
Zhongguo Zhong Yao Za Zhi ; 44(17): 3763-3772, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31602951

RESUMO

The detection of drug-induced anaphylactoid reactions remains a global challenge,still lacking mature and reliable animal models or test methods. Therefore,the purpose of this paper is to explore and establish the test methods and evaluation standards for anaphylactoid reactions that apply to injection drugs. Based on the anaphylactoid reaction symptoms of mice induced by intravenous injection drugs C48/40 and Tween 80,a list of systemic anaphylactoid reaction symptoms in mice was sorted out and an evaluation standard of anaphylactoid reactions symptoms was established by applying symptom intensity coefficient K( that can represent these verity of anaphylactoid reaction symptoms) and its calculation formula Accordingly,histamine,tryptase,and Ig E were selected as blood indicators of anaphylactoid reactions,so that a test method combining symptoms evaluation and blood makers detection was established.This test method could be used to evaluate the characteristics of anaphylactoid reactions: coefficient K,blood histamine levels were highly and positively correlated with C48/80 and Tween 80 dose; The log value of histamine was highly and positively correlated with K; tryptase level may rise,or remain steady,or drop,possibly associated with the characteristics of the tested object and time for blood taking; and Ig E level would drop or remain steady,but it would not rise,which can be clearly distinguished from type I allergic reactions. On this basis,tiohexol,iopromide,paclitaxel,Xuesaitong Injection,Shuanghuanglian Injection and Shengmai Injection were used to investigate the applicability. The testing results showed a high degree of consistency with the actual clinical situation. The results suggest that the method of systemic anaphylaxis test in mice has high sensitivity,specificity and good consistency with clinical practice.It is suggested to be further validated and popularized.


Assuntos
Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Modelos Animais de Doenças , Animais , Medicamentos de Ervas Chinesas/toxicidade , Histamina/sangue , Imunoglobulina E/sangue , Injeções Intravenosas , Camundongos , Choque/induzido quimicamente , Choque/diagnóstico , Testes de Toxicidade , Triptases/sangue
20.
Zhongguo Zhong Yao Za Zhi ; 44(17): 3792-3797, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31602955

RESUMO

This paper was aimed to establish screening methods of anaphylactoid reaction caused by safflower yellow for injection based on RBL-2 H3 cell degranulation model and mice model for acute anaphylactoid reaction,and evaluate the hypersensitivity caused by safflower yellow for injection from different batches. An in vitro cell model was used to keep the cells stimulated for an hour with different batches of safflower yellow for injection as the drug group,serum-free MEM medium as negative control group and 30 mg·L-1 C48/80 as positive control group respectively. The supernatant was then absorbed,and neutral red staining technique was used to detect the effect of safflower yellow injection on the degranulation of RBL-2 H3 cells with the positive cell rate of degranulation as the indicator.An in vivo model was established to validate the experimental results,and mice model for acute anaphylactoid reaction and ELISA method were adopted to detect the plasma histamine content,and screen the hypersensitivity caused by safflower yellow for injection at the animal level by using plasma histamine content as a test index. The results of the neutral red staining experiments showed that the positive control C48/80 could cause cell degranulation,and most of the cells were deeply stained. There was significant difference in positive cell rate between different batches of safflower yellow and positive control group. In the mice model for acute anaphylactoid reaction,it was found that the positive control C48/80 significantly increased the histamine content in the plasma of mice,while the safflower yellow in each batch did not cause a significant increase in plasma histamine( P<0. 000 1). The mechanism of anaphylactoid reaction is relatively complicated. This study was mainly based on the release of histamine and other active substances by degranulation of mast cells. No significant degranulation reaction of RBL-2 H3 cells induced by safflower yellow for injection was detected,nor was the plasma histamine level significantly increased in mice from the in vitro and in vivo aspects.


Assuntos
Anafilaxia/induzido quimicamente , Degranulação Celular/efeitos dos fármacos , Chalcona/análogos & derivados , Mastócitos/efeitos dos fármacos , Animais , Células Cultivadas , Chalcona/efeitos adversos , Histamina/sangue , Camundongos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA