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1.
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
2.
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
3.
Ann Allergy Asthma Immunol ; 125(4): 460-467, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32687987

RESUMO

BACKGROUND: Intravenous recombinant enzyme replacement therapy (ERT) is currently available for 8 lysosomal diseases. Hypersensitivity reactions (HSRs) may be observed during this long-term treatment. OBJECTIVE: To evaluate the frequency and clinical treatment features of ERT HSRs and the management of desensitizations in children. METHODS: Medical records were reviewed retrospectively for patients who received ERT. Those who had experienced HSRs to ERT were included in the study. The demographic characteristics of the patients, culprit enzyme, signs and symptoms, diagnostic tests, management of the reaction, and the protocol employed for the maintenance of ERT were recorded. RESULTS: During the study period, 54 patients received ERT in our institution. A total of 11 patients (20.4%) experienced HSR to ERT. All reactions were of immediate type. The most common symptoms were cutaneous manifestations. A total of 9 patients experienced urticaria, and 2 had anaphylaxis as initial reaction. Patients who had isolated cutaneous symptoms continued their treatments with antihistamines, corticosteroid premedication, slower infusion rate or both. Patients who had recurrent urticaria with these modalities or those who had anaphylaxis continued their ERT with desensitization (n = 8). A total of 3 patients required revisions in desensitization protocols because of recurrent anaphylaxis. CONCLUSION: The reactions that develop during this long-term treatment may be treated by premedication-prolonged infusion, but in some patients, desensitization protocols are necessary for the continuation of therapy. Revisions in desensitization protocols may be required.


Assuntos
Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/imunologia , Terapia de Reposição de Enzimas/efeitos adversos , Doenças por Armazenamento dos Lisossomos/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
6.
JAMA Netw Open ; 3(5): e204199, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32374398

RESUMO

Importance: Allergy to ß-lactam antibiotics is one of the most frequently reported drug reactions, but epidemiological data in Chinese populations are lacking. Ethnic- and region-specific sensitization patterns of skin testing for ß-lactam antibiotic allergy are also unknown. Objective: To identify the prevalence, 1-year incidence, and sensitization patterns of ß-lactam antibiotic allergy in patients in Hong Kong. Design, Setting, and Participants: This cross-sectional study obtained territorywide, anonymized electronic patient data from the Clinical Management Systems of the Hospital Authority, the sole publicly funded health care system in Hong Kong with facilities in 7 regions (Hong Kong East, Hong Kong West, Kowloon Central, Kowloon East, Kowloon West, New Territories East, and New Territories West). All referrals to Queen Mary Hospital for ß-lactam antibiotic allergy testing from January 1, 2018, to December 31, 2019, were also analyzed for sensitization patterns. Main Outcomes and Measures: Prevalence and cumulative incidence of ß-lactam antibiotic allergy reported in Hong Kong, and sensitization patterns according to ß-lactam antibiotic allergy skin testing. Results: Complete records of 7 184 271 unique patients were analyzed, with a men to women ratio of 1:1.2 and with a median age of 44 years. The prevalence of physician-reported ß-lactam antibiotic allergy was 2.0%, and the cumulative incidence was 107 per 100 000 population. Of the 34 402 new drug allergies reported in 2018, 8032 (23.3%) were ß-lactam antibiotic allergies. Three hundred fifty-five patients with reactions suggestive of ß-lactam antibiotic allergy underwent skin testing, and only 49 (13.8%; 95% CI, 10.64%-17.90%) of them had positive test results. Of these 49 patients, 14 (28.6%; 95% CI, 18.35%-44.49%) had selective reaction and 35 (71.4%; 95% CI, 59.84%-85.27%) had nonselective reaction. The sensitization rate to either benzylpenicilloyl polylysine or a minor determinant (benzylpenicilloate) was 47.0% (n = 23; 95% CI, 34.85%-63.21%), with 10 patients monosensitized to benzylpenicilloyl polylysine only (20.4%; 95% CI, 11.74%-35.48%) and 5 to benzylpenicilloate only (10.2%; 95% CI, 4.45%-23.42%). Conclusions and Relevance: Results of this study suggest that patients in Hong Kong with ß-lactam antibiotic allergy had much higher rates of monosensitization to benzylpenicilloyl polylysine and benzylpenicilloate, making these reagents essential in ß-lactam antibiotic skin tests. Such a finding warrants future studies into whether this sensitization is specific to ethnicity or region.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , beta-Lactamas/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , Demografia , Hipersensibilidade a Drogas/etiologia , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Masculino , Prevalência , Testes Cutâneos
7.
Ned Tijdschr Geneeskd ; 1642020 05 07.
Artigo em Holandês | MEDLINE | ID: mdl-32395967

RESUMO

Penicillin allergy is commonly reported and often influences selection of antimicrobial treatment. Due to concerns about cross-allergic reactions, other beta-lactams - particularly cephalosporins - may also be avoided. This too often results in less effective treatment, more side effects and overconsumption of reserve antimicrobial agents. Most patients (> 90%) with a penicillin allergy label are not truly allergic, i.e., they do not have an 'immediate type' (IgE-mediated) allergy when tested. Based on current data, even in patients with a true penicillin allergy, the risk of severe cross-allergic reactions to cephalosporins is very low. Clinicians tend to overestimate this risk: this dilemma can be resolved with a systematic appraisal of risk probabilities. The limited risk of a true penicillin allergy being present and the subsequent low risk of a cross-allergic reaction to cephalosporins generally outweighs the disadvantages of selecting an alternative (non-beta-lactam) antimicrobial regimen.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Hipersensibilidade a Drogas/etiologia , Penicilinas/uso terapêutico , Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Reações Cruzadas , Humanos , Penicilinas/efeitos adversos , Medição de Risco
8.
PLoS One ; 15(4): e0230781, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32243440

RESUMO

BACKGROUND: Gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance imaging (MRI) scans often must be used repeatedly in pediatric oncologic patients. Although GBCAs are usually well tolerated, severe and life-threatening allergic reactions might occur, which can result in overly cautions adherence to special precautions in patients. PURPOSE: To evaluate the management of the reported GBCA-associated adverse reactions in subsequent contrast-enhanced MRIs in pediatric patients, distinguishing non-allergic and allergic reactions. MATERIALS AND METHODS: In this retrospective, cross-sectional study, consecutive pediatric neurooncological patients who underwent GBCA-enhanced MRI at our university hospital, between 2007 and 2016, were eligible. The patients' history was evaluated with regard to any adverse events after GBCA administration. In a subset of patients with reported adverse reactions, the institutional premedication regime or an allergy work-up in clinical practice were performed, using either skin-prick tests or intravenous provocation tests in a double-blind procedure. RESULTS: Included were 8156 contrast-enhanced MRI scans in 2109 patients. Nineteen acute adverse events (19/8156; 0.23%) in 17 patients (17/2109; 0.81%) were reported. Despite a premedication regime in 14 patients, three patients (3/14; 21.4%) reported a breakthrough reaction. None of the 12 patients who underwent skin-prick tests or intravenous provocation tests showed allergic reactions. At least one well-tolerated GBCA was identified in almost every tested patient. CONCLUSION: A fast-track allergy work-up can help to distinguish non-allergic and allergic reactions and to identify a well-tolerated GBCA, thus avoiding unnecessary premedication for subsequent GBCA administrations.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Gadolínio/efeitos adversos , Hipersensibilidade Imediata/etiologia , Imagem por Ressonância Magnética/efeitos adversos , Administração Intravenosa/métodos , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Método Duplo-Cego , Feminino , Humanos , Masculino , Pré-Medicação/métodos , Estudos Retrospectivos , Testes Cutâneos/métodos
9.
Ann Allergy Asthma Immunol ; 124(6): 566-572, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32302769

RESUMO

OBJECTIVE: To review novel concepts in drug hypersensitivity and the management of immediate hypersensitivity reactions. DATA SOURCES: English language literature on MEDLINE and Embase surrounding drug hypersensitivity and desensitization. STUDY SELECTIONS: References were selected based on relevance, date of publication, and originality. RESULTS: There are numerous citations looking at categorizing drug reactions, pathogenesis, biomarkers, and desensitization. Current understanding supports the use of a phenotype-endotype-biomarker model for categorizing immediate hypersensitivity reactions. Drug desensitization is a powerful therapeutic strategy that enables temporary induction of tolerance to medications that triggered immediate reactions. CONCLUSION: Immediate hypersensitivity reactions are diverse in presentation and pathogenesis. Drug desensitization is an effective intervention with sufficient evidence to support its more widespread availability.


Assuntos
Biomarcadores , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Fenótipo , Basófilos , Dessensibilização Imunológica , Gerenciamento Clínico , Suscetibilidade a Doenças , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/terapia , Predisposição Genética para Doença , Custos de Cuidados de Saúde , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/etiologia , Imunoglobulina E , Índice de Gravidade de Doença , Testes Cutâneos
13.
J Oncol Pharm Pract ; 26(5): 1282-1284, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32050851

RESUMO

Monoclonal antibodies were introduced to clinical practice in 1980s and play a vital role in a variety of diseases and clinical interventions including cancer, inflammatory disease, and ophthalmologic disease. There is a lack of substantial research or evidence on the effect of occupational exposure on staff, leading many staff to have significant concerns about what is a safe level of exposure, especially given their increasing availability and use. This report describes a case in which a nurse became sensitised to monoclonal antibodies as a result of preparing and administering them in a clinical area, and the subsequent actions taken in response to the incident to reduce the risk to staff.


Assuntos
Anticorpos Monoclonais/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Enfermeiras e Enfermeiros/normas , Exposição Ocupacional/efeitos adversos , Local de Trabalho , Anticorpos Monoclonais/imunologia , Antineoplásicos Imunológicos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Oncologia/normas , Local de Trabalho/normas , Adulto Jovem
14.
Ann Rheum Dis ; 79(4): 529-535, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32024648

RESUMO

OBJECTIVE: To assess the risk of hypersensitivity reactions (HSRs) with allopurinol and febuxostat in a population-based study. METHODS: We used the 5% Medicare beneficiary sample (≥65 years) from 2006 to 2012 to identify people with a newly filled prescription for allopurinol, febuxostat or colchicine. We used multivariable-adjusted Cox regression analyses to compare the hazard ratio (HR) of incident HSRs with allopurinol or febuxostat use versus colchicine use; separate analyses were done in people exposed to allopurinol. Propensity-matched analyses (5:1) compared hazards with allopurinol versus febuxostat. RESULTS: Crude incidence rates of HSRs were as follows: allopurinol, 23.7; febuxostat, 30.7; and colchicine, 25.6 per 1000 person-years. Compared with colchicine, allopurinol, febuxostat and febuxostat+colchicine were associated with significantly higher HRs of HSRs, 1.32 (95% CI: 1.10 to 1.60) and 1.54 (95% CI: 1.12 to 2.12) and 2.17 (95% CI: 1.18 to 3.99), respectively. In propensity-matched analyses, febuxostat did not significantly differ from allopurinol; HR for HSRs was 1.25 (95% CI: 0.93 to 1.67). Compared with allopurinol start dose <200 mg/day, allopurinol start dose ≥300 mg/day, diabetes and female sex were associated with significantly higher hazard of HSRs, 1.27 (95% CI: 1.12 to 1.44), 1.21 (95% CI: 1.00 to 1.45) and 1.32 (95% CI: 1.17 to 1.48), respectively. The majority (69%) of HSRs occurred in the outpatient setting. CONCLUSIONS: Compared with colchicine, allopurinol and febuxostat similarly increased the risk of HSRs. Allopurinol and febuxostat did not differ from each other. In allopurinol users, starting dose, female sex and diabetes increased this risk, findings that need further study.


Assuntos
Alopurinol/efeitos adversos , Colchicina/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Febuxostat/efeitos adversos , Supressores da Gota/efeitos adversos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Relação Dose-Resposta a Droga , Hipersensibilidade a Drogas/etiologia , Quimioterapia Combinada , Feminino , Humanos , Incidência , Masculino , Medicare , Análise Multivariada , Pontuação de Propensão , Modelos de Riscos Proporcionais , Fatores Sexuais , Estados Unidos/epidemiologia
16.
Ann Allergy Asthma Immunol ; 124(4): 350-356, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31981613

RESUMO

BACKGROUND: Hypersensitivity reactions (HSRs) to chemotherapeutic agents have been increasingly documented. OBJECTIVE: The aim of this study was to investigate HSRs due to chemotherapeutics agents in childhood. METHODS: From January 2007 to June 2019, the patients who were treated for neoplastic diseases in our hospital were evaluated. Patients who developed a HSR to a chemotherapeutic agent were included. RESULTS: Fifty-seven patients with 65 reactions (60% anaphylaxis) were evaluated. Escherichia coli asparaginase was responsible for 38 (58.5%) of these 65 reactions. The other agents were polyethylene glycol (PEG)-asparaginase (n = 11), etoposide (n = 7), methotrexate (n = 4), carboplatin (n = 4), and procarbazine (n = 1). Of the 38 patients who had a reaction to E coli-asparaginase, 33 patients received alternative treatment (PEG-asparaginase or Erwinia asparaginase), 3 patients continued with desensitization, and 2 patients underwent bone marrow transplantation. Five patients who had an initial reaction to PEG-asparaginase continued their treatment with Erwinia asparaginase or E coli asparaginase uneventfully. Of 7 patients who had a reaction to etoposide (4 had anaphylaxis), 3 patients continued with desensitization, and 2 patients used the drug with premedication and prolonged infusion. Two patients had anaphylaxis with methotrexate. Treatment was continued with desensitization in 1 patient and methotrexate treatment was discontinued in the other patient. Of the 4 patients with carboplatin hypersensitivity, 2 had anaphylaxis. Desensitization was performed in 2 patients. One patient had procarbazine HSR, drug was given with premedication. CONCLUSION: Among all chemotherapeutic agents reviewed in our study that caused HSRs, asparaginase was the most common culprit agent in children. Most of reactions are immediate type. Many of the patients can take their treatment by drug replacement or desensitization.


Assuntos
Antineoplásicos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Adolescente , Asparaginase/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Retrospectivos
18.
Am J Med ; 133(4): 452-462.e4, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31647915

RESUMO

BACKGROUND: True allergy to penicillin is rare, despite the high frequency with which it is reported. While most patients reporting penicillin allergy are not prone to anaphylaxis, it is not currently known what percentage of these patients will tolerate dose challenges of penicillin-based antibiotics. This review aims to determine the rate of tolerance in patients reporting penicillin allergy when challenged with penicillin-based antibiotics. METHODS: We searched MedLine, Embase, and Cochrane Library for publications with English language translations between the years 2000 and 2017. We included randomized controlled trials, quasi-experimental, and observational studies of participants reporting penicillin allergy who received at least one systemic dose of a penicillin in the form of a drug challenge. At least 2 independent reviewers extracted data from included studies and assessed the quality of each included study. To generate primary outcome data, we calculated a summary estimate rate of penicillin tolerance from a pooled proportion of participants receiving penicillin with no adverse effects. RESULTS: Initial literature search yielded 2945 studies, of which 23 studies were ultimately included in our review; 5056 study participants with reported history of penicillin allergy were challenged with a penicillin. After weighting for study sample size, a pooled average of 94.4% (95% confidence interval, 93.7%-95%) of participants tolerated the dose challenge without any adverse reaction. CONCLUSION: Misrepresented penicillin allergy drives unnecessary use of alternative antibiotics, which may be less effective, more toxic, and more expensive than using penicillin. In addressing the problem of penicillin allergy over-diagnosis, evaluation should go beyond risk for type 1 hypersensitivity. Our data suggest that 94.4% of 5056 participants with reported penicillin allergy determined to be clinically appropriate for allergy evaluation tolerated repeat administration of penicillin-based antibiotics without any adverse reactions. This review generates meaningful information useful to clinical predictive analytics, in evaluating and managing patients with a reported history of penicillin allergy.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/prevenção & controle , Penicilinas/efeitos adversos , Antibacterianos/administração & dosagem , Hipersensibilidade a Drogas/etiologia , Humanos , Penicilinas/administração & dosagem
19.
Ann Allergy Asthma Immunol ; 124(2): 156-164, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31765812

RESUMO

OBJECTIVE: This review provides an overview of the literature on hypersensitivity reactions during procedures to commonly used contrast agents and dyes. A synthesis of current knowledge on clinical symptoms, epidemiology and risk factors, pathomechanism, and management of hypersensitivity reactions to these substances is presented. DATA SOURCES: A literature search was conducted through Medline. Included were peer-reviewed articles written in English between 2000 and 2019. STUDY SELECTIONS: Relevant clinical studies, experimental studies, and review articles have been selected. Additionally, case reports have been included if they carried significant information about rare clinical forms of hypersensitivity reactions, disease mechanisms, or therapy. RESULTS: An allergological workup is only indicated for patients with a history of immediate (IHR) and nonimmediate hypersensitivity reactions (NIHR) but not for toxic or unrelated adverse events. Skin tests with or without experimental cellular laboratory tests in patients with previous reactions can provide evidence for an allergic mechanism. Positive skin tests indicating allergy are more common in severe reactions. If the adverse event was allergic, skin testing of alternatives is helpful for the selection of other contrast agents for future procedures. Premedication alone may be insufficient in these cases, and breakthrough reactions occur. For nonallergic reactions, change of contrast agent and premedication is often but not always sufficient to suppress reactions. CONCLUSION: Patients with previous NIHR or IHR, especially moderate and severe IHR, needing potential re-administration of contrast agents should be skin tested to identify an allergic mechanism as well as alternative agents to be used for future procedures.


Assuntos
Corantes/efeitos adversos , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Hipersensibilidade a Drogas/diagnóstico , Humanos , Fenótipo , Fatores de Risco
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