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1.
Medicine (Baltimore) ; 100(10): e24915, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725850

RESUMO

RATIONALE: Antibiotic resistance poses a challenge for Helicobacter pylori eradication treatment. Current guidelines strongly recommend avoiding repeated treatments with the same antibiotic to prevent the emergence of drug resistance. However, for penicillin-allergic patients with recurrent H. pylori eradication failures, avoiding repeated treatments with the same antibiotic severely limits the choice of treatment. PATIENT CONCERNS: A 47-year-old woman with a penicillin allergy for whom 2 previous levofloxacin and bismuth-based therapies had failed. DIAGNOSIS: H. pylori infection. INTERVENTIONS: Agar dilution susceptibility testing and gene sequence analysis was performed to confirm levofloxacin susceptibility again. Therefore, we treated her with a 14-day regimen consisting of levofloxacin (500 mg once daily), furazolidone (100 mg twice daily), colloidal bismuth pectin (220 mg twice daily), and esomeprazole (20 mg twice daily). OUTCOMES: The patient was successfully treated with a third levofloxacin and bismuth-based regimen. LESSONS: Antibiotics included in previous failed therapies need not be eliminated if no antibiotic resistance is found on antimicrobial susceptibility testing.


Assuntos
Antibacterianos/farmacologia , Gastrite/tratamento farmacológico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Levofloxacino/farmacologia , Antibacterianos/uso terapêutico , Bismuto/uso terapêutico , DNA Bacteriano/genética , DNA Bacteriano/isolamento & purificação , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/imunologia , Farmacorresistência Bacteriana/genética , Quimioterapia Combinada/métodos , Esomeprazol/uso terapêutico , Feminino , Furazolidona/uso terapêutico , Mucosa Gástrica/patologia , Gastrite/diagnóstico , Gastrite/microbiologia , Gastrite/patologia , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/microbiologia , Infecções por Helicobacter/patologia , Helicobacter pylori/genética , Helicobacter pylori/isolamento & purificação , Humanos , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Penicilinas/imunologia , Penicilinas/uso terapêutico , Recidiva , Retratamento/métodos , Resultado do Tratamento
2.
Acta Biomed ; 92(1): e2021103, 2021 02 09.
Artigo em Inglês | MEDLINE | ID: mdl-33682815

RESUMO

On March 11, 2019 the World Health Organization (WHO) declared Coronavirus disease-2019 (COVID-19), caused by SARS-CoV-2, as a pandemic. As of 15/01/2021, more than ninety million cases of infections have been confirmed, with almost two million related deaths. SARS-CoV-2 causes bilateral interstitial pneumonia, which can responsible of respiratory failure in the most severe cases, but the virus has also a wide range of other manifestations, including gastrointestinal, cardiovascular, neurological, and cutaneous signs and symptoms. Cutaneous manifestations are an important matter of study for allergy specialists, as they can be specific signs of the infection, but also manifestations of adverse reactions to the medical therapy in use. In this case series, we report four different cases of dermatological manifestations in COVID patients, two in hospitalised patients and two in patients with mild disease, treated at home. The first case reported is a woman, who develops urticaria while being treated at home with mild COVID-infection; the second and the third one case reported are drug- hypersensivity reaction to remdesevir and low molecular weight heparin. The last case reported is a man with mild covid with vasculitic sacral lesions. Key words: COVID pandemic, SARS-CoV-2, dermatological manifestation in covid infections, remdesevir hypersensitivity, covid and urticaria, covid and vasculitic lesions.


Assuntos
/complicações , Dermatopatias/etiologia , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Alanina/efeitos adversos , Alanina/análogos & derivados , Diagnóstico Diferencial , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias/diagnóstico
3.
Anaesth Intensive Care ; 49(1): 44-51, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33472385

RESUMO

Making a diagnosis of perioperative anaphylaxis and identifying culprit drugs are diagnostic challenges. The aim of this study is to describe the perioperative presentation of anaphylaxis and results of patients who underwent allergy evaluation. This is a retrospective review of perioperative anaphylaxis of severity Grade 2 and above based on the Australian and New Zealand Anaesthetic Allergy Group criteria from 2015 to 2019 in a tertiary paediatric hospital. Data collected were demographics, clinical features, investigations and management. Of the 35,361 cases of paediatric anaesthesia, there were 15 cases of perioperative anaphylaxis, giving an incidence of four in 10,000. The median age was seven years (interquartile range four-15 years) with a male predominance of 86.7% (13/15). The severity of anaphylaxis was Grade 2 in 33.3% (5/15) and Grade 3 in 66.7% (10/15). The commonest presenting feature was hypotension (13/15, 86.7%) while the earliest symptom was respiratory change (9/15, 60.0%). Dynamic tryptase was raised in 75% (6/8) of the patients with adequate tryptase samples. Eight patients (53.3%) completed allergy testing, of whom five patients (62.5%) had IgE-mediated anaphylaxis with skin test positive to cefazolin (n = 3), atracurium (n = 1) and rocuronium (n = 1). Three patients (25.0%) had non-IgE-mediated reactions with negative skin tests. Although only half the patients completed allergy evaluation, a culprit drug could be identified in 62.5%, with antibiotics being the commonest. This emphasises the need for appropriate evaluation in cases of suspected perioperative anaphylaxis.


Assuntos
Anafilaxia , Hipersensibilidade a Drogas , Adolescente , Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Austrália , Criança , Pré-Escolar , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hospitais Pediátricos , Humanos , Masculino , Nova Zelândia , Estudos Retrospectivos , Testes Cutâneos
4.
Clin Exp Allergy ; 51(3): 463-470, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33394522

RESUMO

BACKGROUND: Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate-type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA-based COVID-19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under-diagnosis and under-reporting of allergy to PEGs, putting patients at risk of repeated severe reactions. OBJECTIVES: To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019. METHOD: Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0-10) before and after diagnosis. RESULTS: Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot-steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2-6). Median time from first reaction to diagnosis was 20 months (range 2-120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis. CONCLUSION AND CLINICAL RELEVANCE: The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients' lives.


Assuntos
Hipersensibilidade a Drogas/complicações , Polietilenoglicóis/efeitos adversos , Adolescente , Adulto , /efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
8.
Clin Dermatol ; 38(6): 648-659, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33341199

RESUMO

Neutrophilic drug reactions are unique eruptions that can affect hospitalized patients and share a common pathophysiology with neutrophils as the key mediators of inflammation. They range in clinical presentation from papules and plaques to bullae and erosions to pustules. Although there is some overlap in presentation, each has distinguishing features that aid the clinician in differentiation from one another and from other drug hypersensitivity reactions. Much of the data on these reactions are from case reports and series or retrospective review studies. There are limited prospective observational studies dedicated to these adverse drug reactions. We review the more common and life-threatening neutrophilic drug reactions, their proposed mechanism of action, and their management.


Assuntos
Erupção por Droga/etiologia , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neutrófilos , Preparações Farmacêuticas , Erupção por Droga/diagnóstico , Erupção por Droga/patologia , Erupção por Droga/terapia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/patologia , Hipersensibilidade a Drogas/terapia , Exantema , Feminino , Halogênios/efeitos adversos , Hidradenite , Humanos , Imunoglobulina A , Masculino , Neutrófilos/imunologia , Paniculite , Pioderma Gangrenoso , Dermatopatias Vesiculobolhosas , Síndrome de Sweet
9.
Allergol. immunopatol ; 48(6): 626-632, nov.-dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-199252

RESUMO

INTRODUCTION: Basophil activation test (BAT) and immunoassays are the most widely used in vitro tests to diagnose IgE-mediated allergic reactions to penicillin. However, studies to determine if one test is interdependent from another are limited. OBJECTIVE: The present study aimed to measure the agreement between BAT and immunoassay in diagnosis of penicillin allergy. METHOD: BAT was performed using penicillin G (Pen G), penicillin V (Pen V), penicilloyl-polylysine (PPL), minor determinant mix (MDM), amoxicillin (Amx) and ampicillin (Amp) in 25 patients. Immunoassay of total IgE (tIgE) and specific IgE (sIgE) antibodies to Pen G, Pen V, Amx and Amp were quantified. Skin prick test (SPT) using PPL-MDM, Amx, Amp and Clavulanic acid were also performed. RESULTS: Minimal agreement was observed between BAT and immunoassay (k = 0.25). Of two BAT-positive patients, one patient is positive to Amx (59.27%, SI = 59) and Amp (82.32%, SI = 82) but sIgE-negative to all drug tested. This patient is also SPT-positive to both drugs. Another patient is BAT-positive to Pen G (10.18%, SI = 40), Pen V (25.07%, SI = 100) and Amp (19.52%, SI = 79). In sIgE immunoassay, four patients were sIgE-positive to at least one of the drugs tested. The sIgE level of three patients was between low and moderate and they were BAT-negative. One BAT-positive patient had a high level of sIgE antibodies (3.5-17.5kU/L) along with relatively high specific to total IgE ratio ≥ 0.002 (0.004-0.007). CONCLUSIONS: The agreement between BAT and immunoassay is minimal. Performing both tests provides little increase in the sensitivity of allergy diagnosis work-up for immediate reactions to penicillin


No disponible


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Teste de Degranulação Basófila/normas , Imunoensaio/normas , Hipersensibilidade a Drogas/diagnóstico , Penicilinase/imunologia , Teste de Degranulação Basófila/métodos , Hipersensibilidade a Drogas/imunologia , Testes Cutâneos/métodos , Imunoglobulina E/sangue , Imunoglobulina E/imunologia , Padrões de Referência
10.
Allergol. immunopatol ; 48(6): 633-639, nov.-dic. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-199253

RESUMO

BACKGROUND: Drug allergies are reactions within the context of drug hypersensitivity reactions, which are caused by immunological mechanisms due to a previously sensitising drug. Beta-lactam antibiotics (BLA) are the leading agents causing drug hypersensitivity reactions in children. The aim of this study is to evaluate the diagnostic importance of in vivo and in vitro diagnostic tests in children with suspected immediate-type BLA hypersensitivity and to investigate the frequency of their use for the final diagnosis. METHODS: Patients admitted to the Outpatient Clinic of Division of Paediatric Allergy and Immunology with suspicion of immediate-type BLA hypersensitivity between December 2014 and December 2018 were investigated. Patients with a history of immediate reactions to BLA were examined by performing drug specific IgE, skin prick tests, intradermal tests and drug provocation tests (DPT). RESULTS: During the study period, 148 patients were admitted to our clinic with suspected immediate-type BLA hypersensitivity. Forty-eight patients completed all assessment steps and were enrolled in the study. It has been shown that 27 patients did not have drug allergy. BLA hypersensitivity was proven in 21 patients by using in vivo test algorithm. More than half of the patients were diagnosed via skin tests with culprit drug. CONCLUSION: Allergy work-up should be performed in patients with immediate reactions to BLA. A skin test can demonstrate BLA hypersensitivity in most patients. Thus, skin tests should be performed prior to the drug provocation test


No disponible


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Hipersensibilidade a Drogas/diagnóstico , beta-Lactamas/imunologia , Testes Imunológicos/métodos , Inibidores de beta-Lactamases/imunologia , beta-Lactamas/efeitos adversos , Testes Cutâneos , Imunoglobulina E/imunologia , Estudos Retrospectivos , Estudos Transversais , Fatores de Tempo , Inibidores de beta-Lactamases/efeitos adversos , Algoritmos
12.
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
13.
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
14.
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.
J Allergy Clin Immunol ; 146(4): 786-789, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32710973

Assuntos
Antivirais/efeitos adversos , Infecções por Coronavirus/tratamento farmacológico , Síndrome da Liberação de Citocina/prevenção & controle , Hipersensibilidade a Drogas/etiologia , Fatores Imunológicos/efeitos adversos , Pneumonia Viral/tratamento farmacológico , Monofosfato de Adenosina/administração & dosagem , Monofosfato de Adenosina/efeitos adversos , Monofosfato de Adenosina/análogos & derivados , Corticosteroides/uso terapêutico , Alanina/administração & dosagem , Alanina/efeitos adversos , Alanina/análogos & derivados , Amidas/administração & dosagem , Amidas/efeitos adversos , Anticorpos Monoclonais Humanizados/administração & dosagem , Anticorpos Monoclonais Humanizados/efeitos adversos , Antivirais/administração & dosagem , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/virologia , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/virologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/imunologia , Humanos , Imunidade Inata/efeitos dos fármacos , Fatores Imunológicos/administração & dosagem , Indóis/administração & dosagem , Indóis/efeitos adversos , Infliximab/administração & dosagem , Infliximab/efeitos adversos , Proteína Antagonista do Receptor de Interleucina 1/administração & dosagem , Proteína Antagonista do Receptor de Interleucina 1/efeitos adversos , Pandemias , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Pirazinas/administração & dosagem , Pirazinas/efeitos adversos , Pirazóis/administração & dosagem , Pirazóis/efeitos adversos , Índice de Gravidade de Doença
17.
Br J Anaesth ; 125(6): 970-975, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32709306

RESUMO

BACKGROUND: Immediate drug hypersensitivity reactions are an increasing public health issue and a frequent cause of life-threatening anaphylaxis. Conventional confirmatory testing include skin tests and, for a few drugs, quantification of drug-specific immunoglobulin E (IgE) antibodies. However, none of these tests are absolutely predictive for the clinical outcome, and can yield false-negative and false-positive results. We performed a proof-of-concept study to assess whether a mast cell activation test could improve diagnosis of IgE-mediated chlorhexidine hypersensitivity, a common cause of perioperative anaphylaxis. METHODS: Human mast cells were generated from CD34+ progenitor cells and sensitised with patients' sera to become IgE+ human mast cells (dMCIgE+), and then incubated with chlorhexidine to assess degranulation. We compared the diagnostic performance of this mast cell activation test with serum from patients with and without positive skin test and basophil activation test to chlorhexidine. RESULTS: In dMC sensitised with sera from patients with a positive skin test and basophil activation test to chlorhexidine showed drug-specific and concentration-dependent degranulation upon stimulation with chlorhexidine, determined by surface upregulation of the degranulation marker CD63. In contrast, dMC sensitised with sera from patients with a negative skin test and basophil activation test to chlorhexidine were unresponsive in the mast cell activation test. CONCLUSIONS: Our study suggests that the mast cell activation test can be used to diagnose IgE/FcεRI-dependent immediate drug hypersensitivity reactions. It also shows potential to assess the clinical relevance of drug-specific IgE antibodies in their ability to elicit mast cell degranulation, and therefore discriminate between allergy and sensitisation. Extended studies are required to verify whether this technique can be used in other causes of perioperative anaphylaxis.


Assuntos
Clorexidina/efeitos adversos , Hipersensibilidade a Drogas/sangue , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Imediata/sangue , Hipersensibilidade Imediata/diagnóstico , Mastócitos/imunologia , Adulto , Idoso , Clorexidina/imunologia , Hipersensibilidade a Drogas/imunologia , Feminino , Humanos , Hipersensibilidade Imediata/imunologia , Masculino , Mastócitos/metabolismo , Pessoa de Meia-Idade
18.
J Pediatr ; 223: 108-113.e2, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32532647

RESUMO

OBJECTIVE: To evaluate the costs associated with evaluation of ß-lactam allergy in children labeled as allergic. STUDY DESIGN: We performed a prospective year-long real life observational study designed to evaluate all pediatric patients with suspected ß-lactam allergy who consulted for allergy evaluation. Direct and indirect costs were systematically recorded. Direct healthcare costs were calculated by taking into account the number of visits and all complementary and diagnostic tests performed. Direct nonhealthcare costs were calculated by considering the number of visits and the kilometers from their homes to the clinic. Finally, indirect costs were evaluated by considering the absenteeism of parents or other companions who took the children to the clinic. RESULTS: A total of 40 children with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct healthcare costs were $5038.03, with an average cost per patient of $125.95. Direct nonhealthcare costs reached $901.87 ($22.55 per patient) and indirect nonhealthcare costs reached $6384.35 ($159.61 per patient). The total cost was $12 324.25, a cost of $308.11 per patient. CONCLUSIONS: Elective evaluation of ß-lactam allergy and delabeling children who are not allergic is not expensive. In addition, it could save future expenses because of an unnecessary lifelong use of alternative antibiotics that are usually more expensive, less effective, and more frequently associated with antimicrobial resistance and different side effects.


Assuntos
Antibacterianos/administração & dosagem , Hipersensibilidade a Drogas/diagnóstico , beta-Lactamas/efeitos adversos , Criança , Análise Custo-Benefício , Hipersensibilidade a Drogas/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Testes Cutâneos/economia
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