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2.
Yonsei Med J ; 61(1): 4-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31887794

RESUMO

The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hipersensibilidade a Drogas/patologia , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/classificação , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/fisiopatologia , Humanos
3.
Med Clin North Am ; 104(1): 109-128, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757230

RESUMO

Drug hypersensitivity reactions (DHRs) may be classified based on timing (immediate vs delayed), mechanisms, and pattern of clinical manifestations. Management may include selection of alternative, non-cross reactive agents, drug allergy testing, graded challenge and/or desensitization. Immediate skin testing only identifies risk for immediate-type allergic DHR and has a negative predictive value for only a limited number of drugs (eg, penicillin). Desensitization induces a temporary state of tolerance that is maintained only so long as the drug is continued. This article discusses special considerations about antibiotics, angiotensin-converting enzyme inhibitors, anesthetic agents, aspirin and nonsteroidal antiinflammatory drugs, radiocontrast media, and chemotherapeutic agents.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Testes Cutâneos/estatística & dados numéricos , Anestésicos/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Humanos , Valor Preditivo dos Testes
4.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757233

RESUMO

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Assuntos
Atenção Primária à Saúde/métodos , Urticária/diagnóstico , Doença Aguda , Comitês Consultivos/normas , Doença Crônica , Hipersensibilidade a Drogas/complicações , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Alimentar/complicações , Hipersensibilidade Alimentar/diagnóstico , Humanos , Guias de Prática Clínica como Assunto , Atenção Primária à Saúde/normas , Prognóstico , Encaminhamento e Consulta , Urticária/etiologia
7.
Am J Case Rep ; 20: 1497-1499, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601777

RESUMO

BACKGROUND Radiofrequency ablation is a minimally invasive treatment for arrhythmias, including frequent ventricular premature. As a complication of radiofrequency ablation, pseudoaneurysm can be treated conservatively or by ultrasound-guided thrombin injection. CASE REPORT We report a case that a possible allergic reaction to thrombin injected into pseudoaneurysm after radiofrequency ablation. CONCLUSIONS We hope that the report of successful management of the allergic reaction in this case may be of help to other doctors; we also emphasize the importance of checking the patient's history of allergies to thrombin when considering treating pseudoaneurysm with thrombin injection.


Assuntos
Falso Aneurisma/terapia , Hipersensibilidade a Drogas/diagnóstico , Artéria Femoral , Hemostáticos/efeitos adversos , Trombina/efeitos adversos , Idoso de 80 Anos ou mais , Alanina Transaminase/sangue , Hipersensibilidade a Drogas/etiologia , Eletrocardiografia , Feminino , Febre/etiologia , Fibrina/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemoglobinas/análise , Hemostáticos/administração & dosagem , Humanos , Hipotensão/etiologia , Injeções Intra-Arteriais , Leucopenia/etiologia , Náusea/etiologia , Ablação por Radiofrequência , Trombina/administração & dosagem , Trombocitopenia/etiologia , Complexos Ventriculares Prematuros/cirurgia
8.
Allergol. immunopatol ; 47(5): 477-483, sept.-oct. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-186522

RESUMO

Introduction and objectives: Drug provocation tests (DPTs) are the gold-standard method to diagnose non-immediate hypersensitivity reactions (NIHSR) to beta-lactam antibiotics (BL) in children. Our aim was to compare the negative predictive value (NPV) of one-day (short) DPT versus 3-7 days (extended) DPT for the diagnosis of NIHSR to BL in paediatric age. A secondary aim was to compare confidence on drug re-exposure after short and extended negative DPTs. Methods: The occurrence of HSR on drug re-exposure and drug refusal after negative diagnostic DPTs were evaluated in children/adolescents with a history of NIHSR to BL using a questionnaire performed six months to ten years after DPT. Patients were divided into two groups according to the protocol performed: short DPT vs. extended DPT. Results: We enrolled 212 children and adolescents (86 females, 126 males, mean age at DPT 5.52 years, p25 = 3 years, p75 = 7.25 years): 69 tested with short DPT, and 143 with extended DPT. The NPV of both types of DPT together was 95.2%. The NPV of short DPT was 97.5% and the NPV of extended DPT was 93.8% (p = 0.419). After negative DPT, beta-lactams were refused by carers in 14.75% of the children requiring subsequent treatment, 6.98% in the short DPT group and 18.99% in the extended DPT group (p = 0.074). Conclusions: In our paediatric sample, prolonging drug administration did not increase the NPV of diagnostic DPT for NIHSR to BL or reduce drug refusal. Altogether, the data here reported suggest that, however intuitive, prolonging DPT is not beneficial in the parameters analysed


No disponible


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Alérgenos/imunologia , Antibacterianos/imunologia , Testes de Provocação Brônquica/métodos , Hipersensibilidade a Drogas/diagnóstico , beta-Lactamas/imunologia , Substituição de Medicamentos , Hipersensibilidade Tardia , Valor Preditivo dos Testes , Prognóstico , Testes Cutâneos
9.
J Assoc Physicians India ; 67(8): 63-65, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562720

RESUMO

The practice of skin testing prior to administration of antibiotics in the absence of a history of allergy is non-existent in the western world. Reports on skin testing in the absence of known allergy are unheard of in the medical literature. The practice of giving a test dose prior to administration of the antibiotic is also practiced very sporadically and has no scientific basis. Despite this In India in most major institutions both in government and private hospitals , general practice set up and small and medium nursing homes, skin testing prior to administration of antibiotics remain extremely common and is even considered to be negligent if not practiced. In this review the evidence for skin testing and test dose before antibiotic administration has been examined. Based on the evidence available skin testing should be restricted to patients with a history of prior penicillin allergy for whom penicillin or other B-lactam antibiotic is the drug of choice and there is no suitable alternative.1 There is no need to do skin testing without a history of penicillin allergy even if the drug is to be administered parenterally. Test dose administration does not protect patients from anaphylactic reactions and hence the practice has no scientific basis.


Assuntos
Antibacterianos/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Testes Cutâneos , Humanos , Índia , Penicilinas
13.
Int Arch Allergy Immunol ; 180(2): 103-112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31394524

RESUMO

Within the broad category of adverse drug reactions in children, there has been a recent focus specifically on the evaluation of children with antibiotic allergy, in particular, beta-lactam allergy. The potential consequences of being labeled beta-lactam allergy are increasingly recognized. Appropriate evaluation of children with suspected reactions to antibiotics is essential as it is increasingly being recognized that the label of "penicillin allergy" is associated with adverse health and economic outcomes. This review will focus on the 3 main classes of antibiotics reported to cause allergic reactions in children: beta lactams (penicillin derivatives and cephalosporins), macrolides, and sulfonamides. This article is a narrative review of the prevalence, diagnosis, and management of different types of antibiotic allergies in children. Our review reveals that antibiotic allergy is often overreported and not appropriately diagnosed in the pediatric age groups. There is a recent shift in the diagnostic paradigm from the use of skin tests and if negative challenges to the use of challenge only in the pediatric age group. Larger studies to establish the usefulness and safety of this new approach as well as updated guidelines are needed.


Assuntos
Hipersensibilidade a Drogas/imunologia , Macrolídeos/imunologia , Testes Cutâneos/métodos , Sulfonamidas/imunologia , beta-Lactamas/imunologia , Anafilaxia/imunologia , Criança , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Humanos , Lactente
14.
Pediatr Clin North Am ; 66(5): 1035-1051, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31466678

RESUMO

Adverse drug reactions are frequently reported in pediatric patients. In this review article, the authors discuss pediatric drug allergies with emphasis on the most common culprits, beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The authors also discuss reactions to non-beta-lactam antibiotics and chemotherapeutics. Skin testing has not yet been validated for many drugs, although notable exceptions include penicillin and carboplatin. The gold standard for diagnosis in most cases remains drug challenge, and the need for penicillin skin testing prior to oral provocation challenge has been questioned in recent studies. Successful desensitizations have also been reported with several drugs.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , beta-Lactamas/efeitos adversos , Criança , Dessensibilização Imunológica , Humanos
15.
Medicine (Baltimore) ; 98(33): e16758, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415373

RESUMO

RATIONALE: Adverse drug reactions (ADRs) to iohexol occur infrequently and generally result in good outcomes. This report describes a 51-year-old man suffering from an ADR to iohexol (Omnipaque 300), which proved fatal. PATIENT CONCERNS: The patient was admitted to hospital due to intermittent dizziness over 2 years and transient numbness and weakness of the right limbs for 1 week. The patient was investigated using carotid artery angioplasty (CAA), during which the patient suffered a sudden disorder of consciousness and a tonic-clonic seizure leading to status epilepticus. After the CAA, the patient suffered from increasing cerebral edema volume. DIAGNOSES: Results of digital subtraction angiography and computed tomography angiography performed at another hospital before the CAA suggested severe stenosis of the left internal carotid artery at the spinal C1 level. In the processes of intraoperative and postoperative CAA, the patient developed severe allergic reactions to the contrast agent including epilepsy, brain tissue edema, and renal failure, which were typical according to the 10th edition of the American College of Radiology Manual on Contrast Media (ACR Manual on Contrast Media, Version 10.3, 2017). INTERVENTIONS: The patient was treated with antiepileptic, antianaphylactic therapy, and control of blood pressure. Due to rapid and severe brain edema, a decompressive craniectomy was performed on the left side, but it was unsuccessful in reducing brain edema. Subsequently, the patient was started on continuous renal replacement therapy for progressive renal dysfunction. OUTCOMES: Despite the use of a variety of medical and surgical interventions, it was not possible to control the patient's condition, which gradually declined leading to death, 7 days post-CAA. LESSONS: To the authors' knowledge, this represents the 1st case of fatal contrast-induced ADR to iohexol during CAA. Although a variety of preoperative tests for iohexol allergy were performed according to recommendations from the ACR Manual on Contrast Media (Version 10.3, 2017), severe complications related to iodized contrast agent still occurred. If the ADR had been recognized sooner and decompressive craniectomy and continuous renal replacement therapy were applied earlier, it would have improved the patients' prognosis.


Assuntos
Artéria Carótida Interna/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Iohexol/efeitos adversos , Angiografia Digital , Estenose das Carótidas/complicações , Tontura/etiologia , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade
16.
Int Immunopharmacol ; 74: 105728, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31288153

RESUMO

BACKGROUND: Rechallenge with oxaliplatin is common in the treatment of colorectal cancer and increases the risk of a detrimental oxaliplatin-induced immune reaction. Allergic reactions to oxaliplatin may be partially avoided by desensitization protocols involving immune suppressive drugs, slow administration and gradually increasing chemotherapeutic doses. However, non-IgE-mediated immunopathologic reactions to oxaliplatin remain challenging and may be potentially life-threatening. CASE PRESENTATION: Here we report two potentially fatal cases of type II hypersensitivity to oxaliplatin in metastatic colorectal cancer patients. Both patients manifested with severe thrombocytopenia, intravascular haemolysis, and acute kidney injury 4-6 h after oxaliplatin administration in a rechallenge setting. Serology revealed that the reactive entity for immune haemolysis was an IgG oxaliplatin-induced antibody. The course of anti-cancer treatment and severe adverse event after oxaliplatin rechallenge including diagnostic dilemma and the results of detailed routine clinical chemistry and hematology testing are described. Extended immunohaematology/serology testing revealed that the oxaliplatin-induced IgG antibody was present in the circulation prior to the onset of hypersensitivity, persisted for months and elicited cross-reactivity with other platinum agents. CONCLUSION: Development of type II hypersensitivity reaction manifesting as a sudden onset of severe thrombocytopenia and immune haemolysis must be considered in patients treated with oxaliplatin, especially those on long-term therapy or when rechallenged. Step-wise diagnosis involves clinical presentation, detection of haemolysis in patient's blood and/or urine, evaluation of platelet count, and direct anti-globulin Coombs test.


Assuntos
Adenocarcinoma/diagnóstico , Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Oxaliplatina/efeitos adversos , Neoplasias Retais/diagnóstico , Lesão Renal Aguda , Adenocarcinoma/complicações , Adenocarcinoma/tratamento farmacológico , Corticosteroides/uso terapêutico , Idoso , Antineoplásicos/uso terapêutico , Dessensibilização Imunológica , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/tratamento farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Feminino , Hemólise , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Oxaliplatina/uso terapêutico , Neoplasias Retais/complicações , Neoplasias Retais/tratamento farmacológico , Trombocitopenia
17.
Ther Umsch ; 75(1): 33-37, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31282835

RESUMO

The diagnosis of drug allergy is essentially based on a detailed anamnesis, involving the doctors who first treated the patient, and skin testing (prick, intradermal and epicutaneous / patch tests). In the allergological practice / clinic, provocation tests with the presumed trigger are only carried out if the indication is very clear (see articles in this issue on drug allergy children, allergies to betalactam and other antibiotics as well as analgesic intolerance). The provocation with a probably tolerable alternative is in the foreground. Unfortunately, the skin tests of certain drug groups have a low sensitivity even under optimal conditions, but very good specificity. Accordingly, positive skin tests are mostly relevant, but negative skin tests cannot rule out an allergy. In recent years, it has therefore proved successful to carry out supplementary laboratory tests in the clarification of drug allergies. The serological tests (IgE) are of little help. In contrast, the test forms based on the analysis of leukocytes (basophil activation test, BAT, and lymphocyte transformation test, LTT) have gained in importance and complement the diagnostic repertoire. In the combination of all test methods (skin test, LTT, BAT, sometimes provocation test) the trigger of a drug allergy can be defined in a good 70 % of cases and in most cases a safe therapeutic alternative can be found. In the following, we will discuss the importance of laboratory diagnostics in drug allergy.


Assuntos
Hipersensibilidade a Drogas , Testes Cutâneos , Antibacterianos , Criança , Hipersensibilidade a Drogas/diagnóstico , Humanos , Ativação Linfocitária , beta-Lactamas
18.
Ther Umsch ; 75(1): 29-31, 2019 07.
Artigo em Alemão | MEDLINE | ID: mdl-31282838

RESUMO

Drug allergy in children: more often suspected than real Abstract. Adverse drug reactions are frequent in the pediatric population. However, only a small proportion of all adverse reactions are drug allergic reactions. About 10 % of the parents report a suspected drug allergy in their children. Even though, no accurate epidemiological data are available, studies suggested that as few as 10 % of those reported an allergy really are. The most common drug allergy among children is a drug hypersensitivity to antibiotics, especially to betalactam antibiotics.In children, one of the major difficulty in the diagnosis of drug allergies, and especially to antibiotics, is the differentiation of maculopapular eruption as an allergic reaction from a viral exanthema, which is very common among children. Therefore, a high number of children are inappropriately labeled as "drug allergic". In case of suspicion of an allergy, it is recommended to perform a complete allergy workup.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas , Exantema , Antibacterianos/imunologia , Criança , Hipersensibilidade a Drogas/diagnóstico , Humanos , Testes Cutâneos , Viroses/diagnóstico , Viroses/patologia
19.
BMC Gastroenterol ; 19(1): 132, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345165

RESUMO

BACKGROUND: Eradicating Helicobacter pylori infection is clinically challenging, notably in cases with penicillin allergy. Cephalosporin could be used in lieu of amoxicillin to eradicate Helicobacter pylori. The current work aimed to assess therapeutic efficacy and safety of a cefuroxime-based quadruple regimen in treatment-naïve individuals with penicillin allergy, as well as patient compliance. METHODS: In the present prospective single-center cohort study, 152 Helicobacter pylori infected individuals with penicillin allergy received eradication therapy with cefuroxime (500 mg twice/day), levofloxacin (500 mg once/day), esomeprazole (20 mg twice/day) and bismuth potassium citrate (220 mg twice/day; 14 days). Safety and compliance were evaluated 1 to 3 days upon eradication. The urea breath test was carried out 8 to 12 weeks upon eradication for efficacy assessment. RESULTS: This quadruple antimicrobial regimen eradicated the pathogen at 85.5% (95% confidence interval (CI) 79.6-90.8%), 88.4% (95% CI 83.0-93.2%) and 90.1% (95% CI 85.2-94.4%) in intention-to-treat, modified intention-to-treat and per-protocol analyses, respectively, with resistance rates of 4.6 and 40.0% in the background of cefuroxime and levofloxacin, respectively. Meanwhile, 21.3% of patients had adverse reactions, but none was serious. A total of 95.3% of patients showed good compliance. Poor compliance and cefuroxime resistance were detected by uni- or multivariate analyses as independent factors predicting therapeutic failure. Eradication rates in patients with dual levofloxacin and cefuroxime susceptibility, isolated levofloxacin resistance, isolated cefuroxime resistance and dual resistance were 97.2, 84.0, 50.0, and 0%, respectively (P = 0.002). CONCLUSIONS: Cefuroxime, levofloxacin, esomeprazole, and bismuth achieved decent efficacy, safety and compliance as first-line antimicrobial regimen in patients with Helicobacter pylori and penicillin allergy.


Assuntos
Cefuroxima/administração & dosagem , Esomeprazol/administração & dosagem , Infecções por Helicobacter , Helicobacter pylori , Levofloxacino/administração & dosagem , Antiácidos/administração & dosagem , Antibacterianos/administração & dosagem , Bismuto/administração & dosagem , Testes Respiratórios/métodos , China , Hipersensibilidade a Drogas/diagnóstico , Quimioterapia Combinada/métodos , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/tratamento farmacológico , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento
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