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2.
Molecules ; 25(21)2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33147821

RESUMO

With an increasing fatality rate, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has emerged as a promising threat to human health worldwide. Recently, the World Health Organization (WHO) has announced the infectious disease caused by SARS-CoV-2, which is known as coronavirus disease-2019 (COVID-2019), as a global pandemic. Additionally, the positive cases are still following an upward trend worldwide and as a corollary, there is a need for a potential vaccine to impede the progression of the disease. Lately, it has been documented that the nucleocapsid (N) protein of SARS-CoV-2 is responsible for viral replication and interferes with host immune responses. We comparatively analyzed the sequences of N protein of SARS-CoV-2 for the identification of core attributes and analyzed the ancestry through phylogenetic analysis. Subsequently, we predicted the most immunogenic epitope for the T-cell and B-cell. Importantly, our investigation mainly focused on major histocompatibility complex (MHC) class I potential peptides and NTASWFTAL interacted with most human leukocyte antigen (HLA) that are encoded by MHC class I molecules. Further, molecular docking analysis unveiled that NTASWFTAL possessed a greater affinity towards HLA and also available in a greater range of the population. Our study provides a consolidated base for vaccine design and we hope that this computational analysis will pave the way for designing novel vaccine candidates.


Assuntos
Betacoronavirus/imunologia , Proteínas do Nucleocapsídeo/imunologia , Sequência de Aminoácidos , Linfócitos T CD8-Positivos/imunologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Hipersensibilidade a Drogas/imunologia , Epitopos de Linfócito B/imunologia , Epitopos de Linfócito T/imunologia , Antígenos de Histocompatibilidade Classe I , Humanos , Modelos Moleculares , Simulação de Acoplamento Molecular , Proteínas do Nucleocapsídeo/química , Fragmentos de Peptídeos/imunologia , Fosfoproteínas , Estrutura Secundária de Proteína , Vacinas Virais/imunologia
3.
Stud Health Technol Inform ; 275: 226-227, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33227775

RESUMO

This paper presents the design and the users' perceptions of a Digital Allergy Card for recording, sharing and tracing information on drug allergies.


Assuntos
Hipersensibilidade a Drogas , Humanos
5.
Am Fam Physician ; 102(10): 613-621, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-33179891

RESUMO

Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.


Assuntos
Anti-Hipertensivos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Crescimento Excessivo da Gengiva/induzido quimicamente , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperpigmentação/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Xerostomia/induzido quimicamente , Albuterol/efeitos adversos , Anlodipino/efeitos adversos , Anticonvulsivantes/efeitos adversos , Atorvastatina/efeitos adversos , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/etiologia , Broncodilatadores/efeitos adversos , Desprescrições , Fluoretos/uso terapêutico , Crescimento Excessivo da Gengiva/terapia , Humanos , Hiperpigmentação/terapia , Lisinopril/efeitos adversos , Losartan/efeitos adversos , Metformina/efeitos adversos , Metoprolol/efeitos adversos , Doenças da Boca/induzido quimicamente , Doenças da Boca/terapia , Omeprazol/efeitos adversos , Higiene Bucal , Inibidores da Bomba de Prótons/efeitos adversos , Sinvastatina/efeitos adversos , Tiroxina/efeitos adversos , Cremes Dentais/uso terapêutico , Xerostomia/terapia
6.
Medicine (Baltimore) ; 99(43): e22814, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120804

RESUMO

RATIONALE: Although the cancer incidence continues to rise, cancer mortality has declined over the past decade, in large part due to more efficacious chemotherapeutic regimens thus, the ability to use first-line chemotherapeutic agents in the treatment of patients with cancer is crucial. Antineoplastic agents can potentially cause toxic and/or hypersensitivity reactions, that can have serious consequences. Anaphylaxis is a big pitfall in oncological patients; the most important aspect in diagnosing anaphylaxis is to precisely identify the offending agent to prevent future events. Paclitaxel (Taxol) is widely used as antitumor medication in the ovarian, breast, non-small-cell lung, and other cancers. Paclitaxel hypersensitivity reactions are frequently described in the literature, but fatalities are rarely reported. Due to the low solubility of paclitaxel, the compound requires dissolution in Cremophor EL, a derivative of castor oil. PATIENT CONCERNS: A 79-year-old man was affected by high-grade non-papillary urothelial carcinoma and underwent a radical cystectomy and prostatectomy with locoregional lymphadenectomy. DIAGNOSIS: Eight months later, relapse was detected, and penis amputation and left nephrostomy were performed. Multiple metastases to lymph nodes were detected. INTERVENTIONS: Palliative chemotherapy was started with Paclitaxel (110 mg) infused at a rate of 50 mL/h. Despite premedication with cetirizine dihydrochloride, dexamethasone, ondansetron, ranitidine, 20 min after Paclitaxel infusion starts, the patient developed general distress, followed by cardiac arrest. OUTCOMES: The mechanism of fatal paclitaxel-associated hypersensitivity reaction is uncertain and its solvent vehicle Cremophor EL may be involved. Several mechanisms have been postulated: an IgE-mediated mast cell degranulation induced by paclitaxel or Cremophor EL, a non-IgE-mediated idiosyncratic mast cell degranulation by paclitaxel or by Cremophor EL, and complement activation. Severe hypersensitivity reactions with fatal outcome are considered rare. LESSONS: The unpredictability and often dramatic reactions of Taxol cause substantial anxiety for doctors and caretakers. They also represent a significant logistic and financial burden on hospitals. Despite premedication, skin testing, and desensitization protocols administration of taxane-based, chemotherapy cannot be considered safe and severe to fatal hypersensitivity reactions cannot be prevented.


Assuntos
Hipersensibilidade a Drogas/etiologia , Glicerol/análogos & derivados , Paclitaxel/efeitos adversos , Neoplasias Urológicas/tratamento farmacológico , Idoso , Hipersensibilidade a Drogas/fisiopatologia , Glicerol/efeitos adversos , Glicerol/uso terapêutico , Humanos , Masculino , Mastócitos/metabolismo , Paclitaxel/uso terapêutico , Triptases/sangue , Neoplasias Urológicas/cirurgia
8.
PLoS Negl Trop Dis ; 14(10): e0008746, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33064728

RESUMO

Leprosy is a stigmatizing, chronic infection which degenerates the nervous system and often leads to incapacitation. Multi-drug therapy which consists of dapsone, rifampicin and clofazimine has been effective to combat this disease. In Indonesia, especially in Papua Island, leprosy is still a problem. Furthermore, there had been higher reports of Dapsone Hypersensitivity Syndrome (DHS) which also challenges leprosy elimination in certain aspects. Globally, DHS has a prevalence rate of 1.4% and a fatality rate up to 13%. The aim of this study is to validate HLA-B*13:01, a previously discovered biomarker for DHS in the Chinese population, as a biomarker for DHS in the Papua population.This is a case-control study of 34 leprosy patients who presented themselves with DHS (case subjects) and 52 leprosy patients without DHS (control subjects). Patients were recruited from 2 provinces: Papua and West Papua. DNA was extracted from 3 ml blood specimens. HLA-B alleles were typed using the gold-standard sequence based typing method. Results were then analysed using logistic regression and risk assessment was carried out. The results of HLA-typing showed that HLA-B*13:01 was the most significant allele associated with DHS, with odds ratio = 233.64 and P-value = 7.11×10-9, confirming the strong association of HLA-B*13:01 to DHS in the Papua population. The sensitivity of this biomarker is 91.2% and specificity is 96.2%, with an area under the curve of 0.95. HLA-B*13:01 is validated as a biomarker for DHS in leprosy patients in Papua, Indonesia, and can potentially be a good predictor of DHS to help prevent this condition in the future.


Assuntos
Dapsona/efeitos adversos , Hipersensibilidade a Drogas/prevenção & controle , Antígeno HLA-B13/genética , Hansenostáticos/efeitos adversos , Hanseníase/tratamento farmacológico , Adolescente , Adulto , Alelos , Biomarcadores , Estudos de Casos e Controles , Clofazimina/administração & dosagem , Dapsona/administração & dosagem , Hipersensibilidade a Drogas/epidemiologia , Quimioterapia Combinada , Feminino , Humanos , Indonésia , Hansenostáticos/administração & dosagem , Modelos Logísticos , Masculino , Rifampina/administração & dosagem , Medição de Risco , Síndrome , Adulto Jovem
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(10): 1060-1068, 2020 Oct 06.
Artigo em Chinês | MEDLINE | ID: mdl-33115190

RESUMO

Drug allergy(DA) is a common clinical allergic disease, and drug provocation tests(DPT) are currently recognized internationally as the "gold standard" for diagnosing drug allergy, but this diagnostic program has not been widely developed in China. The lack of diagnosis of drug allergy increases the risk of medication in clinical, and who also leads to unnecessary drug upgrades and drug abuse. Through consultations with clinical experts in multiple medical fields and combined with domestic rules and regulations to standardize the clinical diagnosis process of drug allergy, the Network of food and drug allergy interest group, Allergy Prevention and Control Committee of Chinese Preventive Medicine Association drafted this consensus for operating specifications of drug provocation tests, and preventing causes improper use of drugs leads to clinical medication risks.


Assuntos
Hipersensibilidade a Drogas , Alérgenos , China , Consenso , Hipersensibilidade a Drogas/diagnóstico , Humanos
11.
Am J Hum Genet ; 107(4): 612-621, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32888428

RESUMO

Hypersensitivity reactions to drugs are often unpredictable and can be life threatening, underscoring a need for understanding their underlying mechanisms and risk factors. The extent to which germline genetic variation influences the risk of commonly reported drug allergies such as penicillin allergy remains largely unknown. We extracted data from the electronic health records of more than 600,000 participants from the UK, Estonian, and Vanderbilt University Medical Center's BioVU biobanks to study the role of genetic variation in the occurrence of self-reported penicillin hypersensitivity reactions. We used imputed SNP to HLA typing data from these cohorts to further fine map the human leukocyte antigen (HLA) association and replicated our results in 23andMe's research cohort involving a total of 1.12 million individuals. Genome-wide meta-analysis of penicillin allergy revealed two loci, including one located in the HLA region on chromosome 6. This signal was further fine-mapped to the HLA-B∗55:01 allele (OR 1.41 95% CI 1.33-1.49, p value 2.04 × 10-31) and confirmed by independent replication in 23andMe's research cohort (OR 1.30 95% CI 1.25-1.34, p value 1.00 × 10-47). The lead SNP was also associated with lower lymphocyte counts and in silico follow-up suggests a potential effect on T-lymphocytes at HLA-B∗55:01. We also observed a significant hit in PTPN22 and the GWAS results correlated with the genetics of rheumatoid arthritis and psoriasis. We present robust evidence for the role of an allele of the major histocompatibility complex (MHC) I gene HLA-B in the occurrence of penicillin allergy.


Assuntos
Artrite Reumatoide/genética , Hipersensibilidade a Drogas/genética , Antígenos HLA-B/genética , Polimorfismo de Nucleotídeo Único , Proteína Tirosina Fosfatase não Receptora Tipo 22/genética , Psoríase/genética , Adulto , Alelos , Artrite Reumatoide/complicações , Artrite Reumatoide/imunologia , Cromossomos Humanos Par 6/química , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/imunologia , Registros Eletrônicos de Saúde , Europa (Continente) , Feminino , Expressão Gênica , Loci Gênicos , Predisposição Genética para Doença , Genoma Humano , Estudo de Associação Genômica Ampla , Antígenos HLA-B/imunologia , Teste de Histocompatibilidade , Humanos , Masculino , Penicilinas/efeitos adversos , Proteína Tirosina Fosfatase não Receptora Tipo 22/imunologia , Psoríase/complicações , Psoríase/imunologia , Autorrelato , Linfócitos T/imunologia , Linfócitos T/patologia , Estados Unidos
15.
Radiol Clin North Am ; 58(5): 841-850, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32792118

RESUMO

Moderate and severe contrast reactions are rare but can be life threatening. Appropriate contrast reaction management is necessary for the best patient outcome. This review summarizes the types and incidences of adverse events to contrast media, treatment algorithms, and equipment needed to treat common contrast reactions, the current status of contrast reaction management training, and preventative strategies to help mitigate adverse contrast events.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Gadolínio/efeitos adversos , Iodo/efeitos adversos , Radiologia/educação , Humanos , Erros de Medicação/prevenção & controle , Fatores de Risco
16.
Am J Emerg Med ; 38(9): 1816-1819, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32738475

RESUMO

OBJECTIVE: To determine the impact of reported beta-lactam allergies on in-hospital mortality and other clinical outcomes in patients who presented with severe sepsis or septic shock. METHODS: This single-center, retrospective cohort study was performed at a 35-bed emergency department in central Kentucky. Patients presenting with sepsis, aged 18years or older, were identified between October 2016 and June 2017. RESULTS: 438 patients with severe sepsis and/or septic shock were identified. Rates of the combined endpoint of in-hospital mortality or transfer to hospice were similar in patients with a beta-lactam allergy (7.2%) versus those with no reported beta-lactam allergy (10.4%) (p=0.41). Time to initiation of antibiotic therapy was slightly longer in the beta-lactam allergic group (2.2h) versus those with no reported beta-lactam allergy (2.15h), but the difference was not statistically significant (p=0.993). Patients were 20.9% more likely to receive an appropriate empiric antibiotic, based off of retrospective culture review, if they did not report a beta-lactam allergy (p=0.009). This led to a delay in effective therapy of 1.59h in the reported beta-lactam allergy arm (p=0.037). CONCLUSIONS: Adequate documentation of beta-lactam allergies is vital to ensure timely and appropriate treatment in patients presenting with severe sepsis and septic shock. Choosing alternative treatment options results in increased time to effective antibiotics, reduced likelihood of covering cultures with first antibiotic, and increased total hospital and variable direct cost.


Assuntos
Antibacterianos/uso terapêutico , Hipersensibilidade a Drogas/epidemiologia , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade , beta-Lactamas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Feminino , Mortalidade Hospitalar , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
17.
Zhonghua Shao Shang Za Zhi ; 36(8): 747-750, 2020 Aug 20.
Artigo em Chinês | MEDLINE | ID: mdl-32829619

RESUMO

A 58-year-old male patient with diabetic foot ulcer was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine on December 11, 2018. The patient was treated with local debridement, vacuum sealing drainage treatment, and dressing change and discharged after basic wound healing. On January 15, 2019, the patient was hospitalized again due to local infection and rupture of wound surface. He underwent a surgical debridement on the third day after second admission and was given intravenous infusion of 0.4 g teicoplanin twice daily. Histopathological examination after surgery showed keratinizing squamous-cell carcinoma. An extended squamous-cell carcinoma resection plus autologous split-thickness skin grafting and vacuum sealing drainage treatment was carried out on the 10th day after second admission. The patient's whole body turned red after surgery with rash, recurrent fever over 39 ℃, leucopenia, and thrombocytopenia. A multi-disciplinary consultation of physicians attributed these symptoms to teicoplanin-induced hypersensitivity syndrome. After withdrawal of teicoplanin and administration of hormone, the patient's temperature returned to normal, and the leucocyte count and platelet count recovered gradually. The patient was cured and discharged on the 49th day after second admission. The case presented reminds us of need to strictly follow the indications of teicoplanin prior to medication, be resolute to the administration and withdrawal, and be alert to adverse drug reactions when above-mentioned abnormalities occur, meanwhile, infection and rheumatic diseases are excluded.


Assuntos
Pé Diabético , Hipersensibilidade a Drogas , Teicoplanina/efeitos adversos , Desbridamento , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Úlcera , Cicatrização
18.
Orv Hetil ; 161(35): 1483-1487, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32822327

RESUMO

Today, insulin hypersensitivity reactions are rare side effects of insulin therapy. In two-thirds of the suspected insulin allergy cases, the clinical symptoms are not related to insulin. The authors report the case of a 64-year-old female patient, by whom lymphocyte tarnsformation test (LTT) has been used to elucidate the background of allergic symptoms developed during insulin therapy. The performed LTT did not support hypersensitivity to insulin, however, the positive protamine test raised the suspicion of fish allergy. Complementary immunoserology also highlighted the coexistence of previously unrevealed thyroid disease. To our knowledge, this is the first documented case report in Hungary that attempts to address the real cause of a suspected hypersensitivity reaction to insulin by using LTT. Orv Hetil. 2020; 161(35): 1483-1487.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipersensibilidade a Drogas/complicações , Insulina/efeitos adversos , Ativação Linfocitária/efeitos dos fármacos , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Hungria , Insulina/administração & dosagem , Pessoa de Meia-Idade
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