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1.
Einstein (Sao Paulo) ; 18: eRC5002, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778467

RESUMO

The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times - the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.


Assuntos
Dessensibilização Imunológica/métodos , Erupção por Droga/tratamento farmacológico , Erupção por Droga/etiologia , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Idoso , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Humanos , Masculino , Sulfametoxazol/efeitos adversos , Trimetoprima/efeitos adversos
2.
J Oncol Pharm Pract ; 26(1): 228-231, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30885040

RESUMO

BACKGROUND: Hypersensitivity reactions to etoposide have been reported and patients have been safely transitioned to etoposide phosphate for continued therapy. However, the safety and efficacy of substituting etoposide phosphate for etoposide has not been well established in pediatric orthopedic malignancies. The aim of this study is to determine whether etoposide phosphate can be substituted for etoposide in pediatric orthopedic malignancies. METHODS: A chart review of pediatric patients who developed hypersensitivity reactions to etoposide while being treated for orthopedic malignancies was performed at a large academic medical center. Three patients were identified, two with Ewing sarcoma and one with an osteosarcoma. All three patients experienced hypersensitivity reactions to their first doses of etoposide and were switched to etoposide phosphate for further therapy. RESULTS: After premedication, all three patients tolerated full doses of etoposide phosphate without a graded dose challenge or desensitization. Two of the patients were premedicated with diphenhydramine alone, while the third received diphenhydramine and dexamethasone. CONCLUSIONS: Etoposide phosphate is a potentially safe alternative for pediatric patients with orthopedic malignancies who experience etoposide hypersensitivity. However, caution is needed as there are cases of etoposide phosphate hypersensitivity.


Assuntos
Neoplasias Ósseas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Etoposídeo/análogos & derivados , Etoposídeo/efeitos adversos , Compostos Organofosforados/uso terapêutico , Osteossarcoma/tratamento farmacológico , Sarcoma de Ewing/tratamento farmacológico , Adolescente , Etoposídeo/uso terapêutico , Humanos , Masculino
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.
Cardiovasc Pathol ; 44: 107154, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31760242

RESUMO

Although the cause of eosinophilic coronary periarteritis (ECPA) remains unclear, an allergic background is present in fewer patients than expected. A 50-year-old man with no history of allergy or symptoms suggestive of cardiac or respiratory disorders suddenly died shortly after oral administration of loxoprofen sodium. Autopsy showed eosinophilic coronary periarteritis in three main branches of the coronary arteries, characterized by eosinophil-predominant inflammation without fibrinoid necrosis or granulomatous change in the adventitia and its surroundings of the three main branches of the coronary arteries, in addition to the localized sign of bronchial asthma in the lung. Immunohistochemical examination showed that many mast cells positive for human mast cell tryptase were evident in the perivascular tissue containing peripheral nerve trunks. Whereas the blood concentration of loxoprofen sodium was within the therapeutic range, significant elevation of the serum histamine and tryptase levels was found. The present case suggests that eosinophilic coronary periarteritis may be caused by a type I allergic reaction in some patients and that loxoprofen sodium can trigger a life-threatening type I allergic reaction, including eosinophilic coronary periarteritis, leading to sudden unexpected death.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Doença da Artéria Coronariana/induzido quimicamente , Vasos Coronários/efeitos dos fármacos , Morte Súbita Cardíaca/etiologia , Hipersensibilidade a Drogas/etiologia , Eosinofilia/induzido quimicamente , Fenilpropionatos/efeitos adversos , Dor de Ombro/tratamento farmacológico , Autopsia , Causas de Morte , Doença da Artéria Coronariana/imunologia , Doença da Artéria Coronariana/patologia , Vasos Coronários/imunologia , Vasos Coronários/patologia , Morte Súbita Cardíaca/patologia , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/patologia , Eosinofilia/imunologia , Eosinofilia/patologia , Evolução Fatal , Humanos , Masculino , Mastócitos/efeitos dos fármacos , Mastócitos/imunologia , Mastócitos/patologia , Pessoa de Meia-Idade
5.
South Med J ; 112(11): 591-597, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31682741

RESUMO

OBJECTIVE: The primary objective of this study was to determine whether patients prescribed nonpreferred antibiotics received appropriate alternative antibiotics. METHODS: This was a retrospective observational analysis of military veteran patients with a ß-lactam allergy treated in an outpatient clinic or emergency department for an infection during a 5-year span. Antibiotic regimens were first stratified as preferred or nonpreferred based on infection-specific guidelines. The nonpreferred regimens were then evaluated for appropriateness based on allergy history and culture and sensitivity reports. RESULTS: Of 445 fills of antibiotics evaluated, 269 met inclusion criteria, comprising 253 unique infections in 80 patients. Patients received nonpreferred antibiotics for their infection type in 57% of cases. Of the nonpreferred antibiotics, 56% were inappropriate based on guideline-recommended alternatives, allergy history, and culture and sensitivity data. Of the 88 allergies, 97% were historical/self-reported and 48% were cutaneous. In addition, 39% of patients safely received ß-lactam antibiotics after documentation of their allergy. CONCLUSIONS: Patients with documented ß-lactam allergies are at high risk of receiving nonpreferred and inappropriate antibiotics, and many reactions likely do not reflect true allergies. These data emphasize the negative impact of the "ß-lactam allergy" label and the importance of reassessing allergies.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Prescrições de Medicamentos/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , beta-Lactamas/efeitos adversos , Idoso , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Ambulatório Hospitalar , Estudos Retrospectivos , Tennessee , Veteranos
6.
Crit Care Resusc ; 21(4): 265-73, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31778633

RESUMO

OBJECTIVE: To determine the prevalence and impact of patient-reported antibiotic allergies in the intensive care unit (ICU), which are currently poorly defined. Antibiotic allergy labels (AALs) are associated with inappropriate antibiotic prescribing and with inferior patient, microbiological and hospital outcomes. DESIGN: Prospective, single-centre case-control study. SETTING: Mixed ICU, Austin Hospital, Melbourne. PARTICIPANTS: All adults (≥ 18 years old) admitted to the ICU who received at least two doses of systemic antibiotics between 12 February and 20 April 2018. MAIN OUTCOME MEASURES: Demographic data, infection and allergy history, antibiotic prescriptions and ICU interventions and outcomes. RESULTS: Of the 247 patients (79.9%) who received systemic antibiotics, 43 patients (17.4%) had an AAL and 204 (82.6%) did not. A higher proportion of patients with AAL were female (P = 0.032) and received vancomycin (37.2% AAL v 18.6% no antibiotic allergies [NAAL]; P = 0.014), and a lower proportion of patients received narrow spectrum ß-lactams (39.5% AAL v 58.8% NAAL; P = 0.028). On multivariable logistic regression, the AAL cohort had twice higher odds of receiving vancomycin (odds ratio [OR], 2.04; 95% CI, 1.07-3.86; P = 0.029) and half the odds of receiving a narrow spectrum ß-lactam (OR, 0.52; 95% CI, 0.29-0.94; P = 0.03). AAL distribution on the electronic medical record included 17% type A (predictable), 13% type B-I (immediate), 2% type B-IV (delayed), 35% type B (unspecified), and 32% unknown. An interview clarifying allergy phenotype found that 59.5% of AALs matched their documented description. CONCLUSION: Patients with AALs had twice the odds of receiving intravenous vancomycin and half the odds of receiving narrow spectrum ß-lactams, which highlights the continued need for antimicrobial stewardship initiatives.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Adolescente , Adulto , Antibacterianos/imunologia , Antibacterianos/uso terapêutico , Austrália , Estudos de Casos e Controles , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Prevalência , Estudos Prospectivos , Vancomicina/efeitos adversos , beta-Lactamas/efeitos adversos
8.
Int J Mol Sci ; 20(20)2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31600977

RESUMO

A high incidence of hypersensitivity reactions (HSRs) largely limits the use of paclitaxel injection. Currently, these reactions are considered to be mediated by histamine release and complement activation. However, the evidence is insufficient and the molecular mechanism involved in paclitaxel injection-induced HSRs is still incompletely understood. In this study, a mice model mimicking vascular hyperpermeability was applied. The vascular leakage induced merely by excipients (polyoxyl 35 castor oil) was equivalent to the reactions evoked by paclitaxel injection under the same conditions. Treatment with paclitaxel injection could cause rapid histamine release. The vascular exudation was dramatically inhibited by pretreatment with a histamine antagonist. No significant change in paclitaxel injection-induced HSRs was observed in complement-deficient and complement-depleted mice. The RhoA/ROCK signaling pathway was activated by paclitaxel injection. Moreover, the ROCK inhibitor showed a protective effect on vascular leakage in the ears and on inflammation in the lungs. In conclusion, this study provided a suitable mice model for investigating the HSRs characterized by vascular hyperpermeability and confirmed the main sensitization of excipients in paclitaxel injection. Histamine release and RhoA/ROCK pathway activation, rather than complement activation, played an important role in paclitaxel injection-induced HSRs. Furthermore, the ROCK inhibitor may provide a potential preventive approach for paclitaxel injection side effects.


Assuntos
Antineoplásicos Fitogênicos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/metabolismo , Paclitaxel/efeitos adversos , Transdução de Sinais , Quinases Associadas a rho/metabolismo , Proteína rhoA de Ligação ao GTP/metabolismo , Animais , Antineoplásicos Fitogênicos/administração & dosagem , Biópsia , Ativação do Complemento/imunologia , Proteínas do Sistema Complemento/imunologia , Proteínas do Sistema Complemento/metabolismo , Modelos Animais de Doenças , Hipersensibilidade a Drogas/patologia , Feminino , Liberação de Histamina , Masculino , Camundongos , Paclitaxel/administração & dosagem
9.
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
10.
Med Sci (Paris) ; 35(8-9): 682-688, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31532381

RESUMO

Multi-elemental imaging of soft tissues using Laser-induced breakdown spectroscopy, also known as LIBS, allows for the direct visualization of the distribution of endogenous or exogenous elements within tissues. LIBS was used to image the kinetics of metal nanoparticles in elimination organs, but also the physiological distribution of biological elements in situ and the topography of chemicals or metals in exposed human tissues. Based on our experience and recent literature in the field of imaging the elemental content of animal and human specimens, this review describes the principle and characteristics of the instrument, technical considerations for setting up experiments with LIBS, its advantages, limitations and possibilities for pre-clinical and medical applications.


Assuntos
Diagnóstico por Imagem/tendências , Lasers , Análise Espectral/métodos , Alumínio/efeitos adversos , Alumínio/química , Animais , Diagnóstico por Imagem/métodos , Hipersensibilidade a Drogas/etiologia , Estudos de Avaliação como Assunto , Humanos
13.
Arch. Soc. Esp. Oftalmol ; 94(9): 441-444, sept. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186223

RESUMO

Una mujer de 58 años presentó quemosis intensa y oftalmoparesia en el ojo izquierdo 8 h después de cirugía de catarata no complicada bajo anestesia subtenoniana. Tras tratamiento corticoideo y antihistamínico, se observó recuperación de la motilidad extrínseca pero se apreciaron un edema de papila no hemorrágico y un defecto concéntrico de campo visual. El caso evolucionó a atrofia papilar con agudeza visual central preservada pero con una contracción significativa del campo visual. El estudio etiológico reveló una alergia a la hialuronidasa, usada como adyuvante a la anestesia. Esta complicación debe ser diagnosticada y tratada precozmente, puesto que el edema de los tejidos orbitarios puede dañar el nervio óptico


A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8 hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Adjuvantes Anestésicos/efeitos adversos , Hipersensibilidade a Drogas/complicações , Hialuronoglucosaminidase/efeitos adversos , Síndromes de Compressão Nervosa/induzido quimicamente , Doenças do Nervo Óptico/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Adjuvantes Anestésicos/imunologia , Diagnóstico Tardio , Hipersensibilidade a Drogas/etiologia , Edema/etiologia , Doenças Palpebrais/etiologia , Hialuronoglucosaminidase/imunologia , Isquemia/etiologia , Oftalmoplegia/induzido quimicamente , Facoemulsificação , Distúrbios Pupilares/induzido quimicamente , Vasos Retinianos , Tomografia de Coerência Óptica , Campos Visuais
14.
Braz J Infect Dis ; 23(4): 268-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31374183

RESUMO

Abacavir can cause a multi-systemic hypersensitivity reaction (HSR) in 5-8% of the patients, which is related to HLA-B*57-01 allele. In Brazil, the HLA-B*57-01 screening test became available only in March 2018, several years after abacavir was in use. In this retrospective study we reviewed medical charts of all patients receiving an abacavir-containing regimen to evaluate the frequency of HSR in patients followed at a referral center in Salvador, Brazil. A total of 192 patients who received abacavir were identified, most male (67.1%), black or racially mixed (77.8%), and having diagnosis of a previous AIDS defining conditions (83.7%). Only one patient developed HSR (incidence: 0.52%). The main reasons for abacavir-containing antiretroviral therapy discontinuation were virological failure (28%), adverse effects to other components of the regimen (25%), and simplification of therapy (16%). The low incidence of HSR to abacavir does not support the use of HLA-B*57-01 screening test, in Salvador, Brazil.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Didesoxinucleosídeos/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Infecções por HIV/tratamento farmacológico , Adulto , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos
15.
Sensors (Basel) ; 19(16)2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31416185

RESUMO

Pre-treatment screening of individuals for human leukocyte antigens (HLA) HLA-B*57:01 is recommended for the prevention of life-threatening hypersensitivity reactions to abacavir, a drug widely prescribed for HIV treatment. However, the implementation of screening in clinical practice is hindered by the slow turnaround time and high cost of conventional HLA genotyping methods. We have developed a biosensor platform using interdigitated electrode (IDE) functionalized with a monoclonal antibody to detect cells expressing HLA-B*57:01. This platform was evaluated using cell lines and peripheral blood mononuclear cells expressing different HLA-B alleles. The functionalized IDE sensor was able to specifically capture HLA-B*57:01 cells, resulting in a significant change in the impedance magnitude in 20 min. This IDE platform has the potential to be further developed to enable point-of-care HLA-B*57:01 screening.


Assuntos
Técnicas Biossensoriais/métodos , Didesoxinucleosídeos/efeitos adversos , Hipersensibilidade a Drogas/prevenção & controle , Antígenos HLA-B/análise , Leucócitos Mononucleares/metabolismo , Alelos , Anticorpos Imobilizados/química , Anticorpos Imobilizados/imunologia , Anticorpos Monoclonais/química , Anticorpos Monoclonais/imunologia , Didesoxinucleosídeos/uso terapêutico , Hipersensibilidade a Drogas/etiologia , Técnicas Eletroquímicas , Eletrodos , Infecções por HIV/tratamento farmacológico , Antígenos HLA-B/genética , Antígenos HLA-B/imunologia , Humanos
16.
Pediatr Rheumatol Online J ; 17(1): 57, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438986

RESUMO

BACKGROUND: The anti-interleukin-6 receptor-alpha antibody tocilizumab was approved for intravenous (IV) injection in the treatment of patients with systemic juvenile idiopathic arthritis (sJIA) aged 2 to 17 years based on results of a randomized controlled phase 3 trial. Tocilizumab treatment in systemic juvenile idiopathic arthritis (sJIA) patients younger than 2 was investigated in this open-label phase 1 trial and compared with data from the previous trial in patients aged 2 to 17 years. METHODS: Patients younger than 2 received open-label tocilizumab 12 mg/kg IV every 2 weeks (Q2W) during a 12-week main evaluation period and an optional extension period. The primary end point was comparability of pharmacokinetics during the main evaluation period to that of the previous trial (in patients aged 2-17 years), and the secondary end point was safety; pharmacodynamics and efficacy end points were exploratory. Descriptive comparisons for pharmacokinetics, pharmacodynamics, safety, and efficacy were made with sJIA patients aged 2 to 17 years weighing < 30 kg (n = 38) who received tocilizumab 12 mg/kg IV Q2W in the previous trial (control group). RESULTS: Eleven patients (mean age, 1.3 years) received tocilizumab during the main evaluation period. The primary end point was met: tocilizumab exposures for patients younger than 2 were within the range of the control group (mean [±SD] µg/mL concentration at the end-of-dosing interval [Cmin]: 39.8 [±14.3] vs 57.5 [±23.3]; maximum concentration [Cmax] postdose: 288 [±40.4] vs 245 [±57.2]). At week 12, pharmacodynamic measures were similar between patients younger than 2 and the control group; mean change from baseline in Juvenile Arthritis Disease Activity Score-71 was - 17.4 in patients younger than 2 and - 28.8 in the control group; rash was reported by 14.3 and 13.5% of patients, respectively. Safety was comparable except for the incidence of serious hypersensitivity reactions (27.3% in patients younger than 2 vs 2.6% in the control group). CONCLUSIONS: Tocilizumab 12 mg/kg IV Q2W provided pharmacokinetics, pharmacodynamics, and efficacy in sJIA patients younger than 2 comparable to those in patients aged 2 to 17 years. Safety was comparable except for a higher incidence of serious hypersensitivity events in patients younger than 2 years. CLASSIFICATION: Juvenile idiopathic arthritis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01455701 . Registered, October 20, 2011, Date of enrollment of first participant: October 26, 2012.


Assuntos
Anticorpos Monoclonais Humanizados/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Juvenil/tratamento farmacológico , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticorpos Monoclonais Humanizados/farmacocinética , Antirreumáticos/efeitos adversos , Antirreumáticos/farmacocinética , Esquema de Medicação , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Lactente , Masculino , Resultado do Tratamento
17.
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
19.
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
20.
Arch Soc Esp Oftalmol ; 94(9): 441-444, 2019 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31280939

RESUMO

A 58 year-old woman presented with severe chemosis and ophthalmoparesis on her left eye 8hours after uncomplicated cataract surgery under sub-tenon anaesthesia. Recovery of extrinsic motility was observed after corticosteroid and antihistamine treatment, but a non-haemorrhagic papillary oedema and a concentric defect of visual field were found. It progressed to papillary atrophy with preserved central vision, but with a significant visual field constriction. The aetiological study revealed an allergy to hyaluronidase that was used as adjuvant to the anaesthesia. This complication needs to be promptly diagnosed and treated, as the swelling of the orbital tissues can cause damage to the optic nerve.


Assuntos
Adjuvantes Anestésicos/efeitos adversos , Hipersensibilidade a Drogas/complicações , Hialuronoglucosaminidase/efeitos adversos , Síndromes de Compressão Nervosa/induzido quimicamente , Doenças do Nervo Óptico/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Adjuvantes Anestésicos/imunologia , Diagnóstico Tardio , Hipersensibilidade a Drogas/etiologia , Edema/etiologia , Doenças Palpebrais/etiologia , Feminino , Humanos , Hialuronoglucosaminidase/imunologia , Isquemia/etiologia , Pessoa de Meia-Idade , Oftalmoplegia/induzido quimicamente , Facoemulsificação , Distúrbios Pupilares/induzido quimicamente , Vasos Retinianos , Tomografia de Coerência Óptica , Campos Visuais
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