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1.
Rev Alerg Mex ; 69 Suppl 1: s81-s93, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-34998313

RESUMO

Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Antibacterianos/efeitos adversos , Carbapenêmicos , Cefalosporinas/efeitos adversos , Reações Cruzadas , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Humanos , Penicilinas/efeitos adversos , Testes Cutâneos
2.
Handb Exp Pharmacol ; 268: 195-212, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219202

RESUMO

Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type reactions reveal a high variability. In both cases it may not always be easy to differentiate drug reactions from non-drug-induced skin conditions. Furthermore, the different types of cutaneous adverse reactions may be difficult to distinguish in the beginning. This accounts predominately for delayed hypersensitivity reactions that can occur after a variety of medications and present with manifold lesions. Most of these cutaneous adverse reactions are mild, but some are severe with high morbidity and mortality. In the clinical setting, it is important to recognize the signs that point to a more severe condition early on in order to initiate appropriate management. In addition, it is crucial to identify the potentially culprit medication on the basis of a detailed medication history and by evaluating the relevant exposure times of certain drugs that differ substantially between the various reaction types. After the acute stage of the adverse reaction is managed successfully, further allergologic testing may be undertaken to confirm the offending drug.


Assuntos
Hipersensibilidade a Drogas , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Humanos , Pele , Testes Cutâneos
4.
JAMA Netw Open ; 4(12): e2140364, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34935921

RESUMO

Importance: Little is known about the factors associated with COVID-19 vaccine adverse effects in a real-world population. Objective: To evaluate factors potentially associated with participant-reported adverse effects after COVID-19 vaccination. Design, Setting, and Participants: The COVID-19 Citizen Science Study, an online cohort study, includes adults aged 18 years and older with a smartphone or internet access. Participants complete daily, weekly, and monthly surveys on health and COVID-19-related events. This analysis includes participants who provided consent between March 26, 2020, and May 19, 2021, and received at least 1 COVID-19 vaccine dose. Exposures: Participant-reported COVID-19 vaccination. Main Outcomes and Measures: Participant-reported adverse effects and adverse effect severity. Candidate factors in multivariable logistic regression models included age, sex, race, ethnicity, subjective social status, prior COVID-19 infection, medical conditions, substance use, vaccine dose, and vaccine brand. Results: The 19 586 participants had a median (IQR) age of 54 (38-66) years, and 13 420 (68.8%) were women. Allergic reaction or anaphylaxis was reported in 26 of 8680 participants (0.3%) after 1 dose of the BNT162b2 (Pfizer/BioNTech) or mRNA-1273 (Moderna) vaccine, 27 of 11 141 (0.2%) after 2 doses of the BNT162b2 or mRNA-1273 vaccine or 1 dose of the JNJ-78436735 (Johnson & Johnson) vaccine. The strongest factors associated with adverse effects were vaccine dose (2 doses of BNT162b2 or mRNA-1273 or 1 dose of JNJ-78436735 vs 1 dose of BNT162b2 or mRNA-1273; odds ratio [OR], 3.10; 95% CI, 2.89-3.34; P < .001), vaccine brand (mRNA-1273 vs BNT162b2, OR, 2.00; 95% CI, 1.86-2.15; P < .001; JNJ-78436735 vs BNT162b2: OR, 0.64; 95% CI, 0.52-0.79; P < .001), age (per 10 years: OR, 0.74; 95% CI, 0.72-0.76; P < .001), female sex (OR, 1.65; 95% CI, 1.53-1.78; P < .001), and having had COVID-19 before vaccination (OR, 2.17; 95% CI, 1.77-2.66; P < .001). Conclusions and Relevance: In this real-world cohort, serious COVID-19 vaccine adverse effects were rare and comparisons across brands could be made, revealing that full vaccination dose, vaccine brand, younger age, female sex, and having had COVID-19 before vaccination were associated with greater odds of adverse effects. Large digital cohort studies may provide a mechanism for independent postmarket surveillance of drugs and devices.


Assuntos
/efeitos adversos , /efeitos adversos , COVID-19/prevenção & controle , /administração & dosagem , Adulto , Fatores Etários , Idoso , Anafilaxia/induzido quimicamente , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Esquemas de Imunização , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Fatores Sexuais
5.
J Med Case Rep ; 15(1): 565, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34819140

RESUMO

BACKGROUND: Excipients are widely used in pharmaceuticals, detergents, food, and drink because of their properties of low toxicity and hypoallergenicity. The excipient carboxymethylcellulose is used extensively as a thickener in foods such as baked goods, ice cream, gluten free, and reduced fat products, where it may be labeled as e-number E466. However, excipients can rarely cause type 1 hypersensitivity reactions. Several publications have described systemic allergy following carboxymethylcellulose exposure in pharmaceuticals, particularly systemic corticosteroids. Furthermore, there is one reported case in the literature of anaphylaxis following food containing carboxymethylcellulose. CASE PRESENTATION: We identify a case of anaphylaxis in a 45-year-old atopic Caucasian woman on receiving an injectable suspension of the corticosteroid triamcinolone acetonide containing carboxymethylcellulose, and subsequent allergic symptoms on reexposure to carboxymethylcellulose in a commercial drink. Diagnosis of carboxymethylcellulose excipient allergy was confirmed through skin prick testing using Celluvisc carmellose 0.5% eye drops, which contain carboxymethylcellulose as the active ingredient. CONCLUSION: This case highlights the importance of identifying excipients such as carboxymethylcellulose as causes of allergy, to reduce burden of further hypersensitivity reactions, not just to drugs but to other consumables.


Assuntos
Anafilaxia , Hipersensibilidade a Drogas , Anafilaxia/induzido quimicamente , Anafilaxia/tratamento farmacológico , Anafilaxia/prevenção & controle , Carboximetilcelulose Sódica , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Excipientes/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Testes Cutâneos
6.
J Hematol Oncol ; 14(1): 182, 2021 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-34717720

RESUMO

Asparaginase is an important drug to treat childhood haematological malignancies. Data on the association between human leukocyte antigens (HLA) and asparaginase hypersensitivity among Chinese are lacking. We conducted a retrospective study to identify HLA alleles associated with asparaginase hypersensitivity among Chinese children with acute lymphoblastic leukaemia (ALL), mixed phenotype leukaemia and non-Hodgkin lymphoma (NHL), who received asparaginases with HLA typing performed between 2009 and 2019. 107 Chinese patients were analysed. 66.3% (71/107) developed hypersensitivity to at least one of the asparaginases. HLA-B*46:01 (OR 3.8, 95% CI 1.4-10.1, p < 0.01) and DRB1*09:01 (OR 4.3, 95% CI 1.6-11.4, p < 0.01) were significantly associated with L-asparaginase hypersensitivities, which remained significant after adjustment for age, gender and B cell ALL [HLA-B*46:01 (adjusted OR 3.5, 95% 1.3-10.5, p = 0.02) and DRB1*09:01 (OR 4.4, 95% CI 1.6-13.3, p < 0.01)].


Assuntos
Antineoplásicos/efeitos adversos , Asparaginase/efeitos adversos , Hipersensibilidade a Drogas/genética , Antígenos HLA/genética , Alelos , Antineoplásicos/uso terapêutico , Asparaginase/uso terapêutico , Criança , Pré-Escolar , China/epidemiologia , Hipersensibilidade a Drogas/etiologia , Feminino , Predisposição Genética para Doença , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Estudos Retrospectivos
7.
Front Immunol ; 12: 654190, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34497600

RESUMO

Delayed-type drug hypersensitivity reactions (dtDHR) are immune-mediated reactions with skin and visceral manifestations ranging from mild to severe. Clinical care is negatively impacted by a limited understanding of disease pathogenesis. Though T cells are believed to orchestrate disease, the type of T cell and the location and mechanism of T cell activation remain unknown. Resident memory T cells (TRM) are a unique T cell population potentially well situated to act as key mediators in disease pathogenesis, but significant obstacles to defining, identifying, and testing TRM in dtDHR preclude definitive conclusions at this time. Deeper mechanistic interrogation to address these unanswered questions is necessary, as involvement of TRM in disease has significant implications for prediction, diagnosis, and treatment of disease.


Assuntos
Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Tardia/diagnóstico , Hipersensibilidade Tardia/etiologia , Memória Imunológica , Pele/imunologia , Linfócitos T/imunologia , Animais , Suscetibilidade a Doenças , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/metabolismo , Humanos , Hipersensibilidade Tardia/metabolismo , Ativação Linfocitária , Pele/efeitos dos fármacos , Pele/metabolismo , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Linfócitos T/metabolismo
8.
Clin J Oncol Nurs ; 25(5): 511-513, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533506

RESUMO

Pegaspargase, a chemotherapy drug known to improve survival outcomes in acute lymphoblastic leukemia, is associated with a risk for hypersensitivity reactions. At a children's hospital in the midwestern United States, two patients developed unusual reactions consisting of disseminated urticaria about two weeks after their second dose of pegaspargase. Both patients then proceeded to have severe anaphylaxis with the third dose of pegaspargase. These cases highlight the importance of advanced practice nurses being alert for the occurrence of unusual and delayed reactions to chemotherapy administration.


Assuntos
Anafilaxia , Hipersensibilidade a Drogas , Urticária , Anafilaxia/induzido quimicamente , Anafilaxia/diagnóstico , Asparaginase/efeitos adversos , Criança , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Humanos , Polietilenoglicóis , Urticária/induzido quimicamente , Urticária/diagnóstico
9.
Int J Clin Pract ; 75(11): e14766, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34473887

RESUMO

BACKGROUND: Iodinated contrast media (ICM) is a frequently used compound in radiology. Non-immediate hypersensitivity reactions (HSR) appear when a patient leaves the department and usually are undocumented. True hypersensitivity in this group is rarely proved. METHODS: Single-centre 2014-2018 data were retrospectively analysed. HSR to ICM were classified and investigated according to the time of occurrence (immediate <1 hour, non-immediate >1 hour). ENDA questionnaire and skin tests (prick or intradermal test) were performed according to ENDA/EAACI recommendations. RESULTS: 69 patients with a clinical history of HSR to ICM were identified, 72.46% were females (n = 50). The average age was 56 (SD ± 13.16) years. Non-immediate HSR occurred in 28.99% (n = 20) patients. The suspected culprit drugs were: iodixanol 20% (n = 4), iopromide 5% (n = 1), diatrizoate 10% (n = 2) and iohexol 10% (n = 2). Among non-immediate HSR 96.00% (n = 19) of patients had skin rashes. A statistically significant correlation was found between the clinical symptoms and the type of reaction (p-value <0.05): isolated skin manifestations mostly occurred in non-immediate HSR 75.00% (n = 15). Only 13.04% (n = 9) of all the patients were proved to be allergic to a certain ICM after the proposed diagnostic workup. CONCLUSIONS: One-third of the hypersensitivity reactions investigated were classified as non-immediate type. Most of them manifested with isolated skin symptoms. The most frequent culprit drug encountered was iodixanol. The overall non-immediate hypersensitivity confirmation rate after diagnostic evaluation was only 15%.


Assuntos
Hipersensibilidade a Drogas , Compostos de Iodo , Adulto , Idoso , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Testes Cutâneos
10.
Turk J Med Sci ; 51(5): 2233-2242, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34333906

RESUMO

Coronavirus Disease 2019 (COVID-19) affected the whole world in a short time. One of the most influential public health initiatives modern medicine has to offer, the vaccine has become even more important as the COVID-19 pandemic continues to worsen worldwide. Many vaccine trials were launched during the COVID-19 pandemic, and these vaccines were widely used around the world, offering realistic hope for ending the pandemic. Allergic reactions to vaccines were reported shortly after their approval. These reactions, in general, are rare, but, in some circumstances, they can be serious. Allergy to vaccines can occur because of either the active vaccine component or vaccine ingredients. The spectrum of the reactions may be just a local hypersensitiviy reaction or may be as severe as an anaphylaxis, which is an acute severe, life-threatening systemic hypersensitive reaction, and it requires quick intervention. If an allergy is suspected, a correct examination followed by algorithms is important for true diagnosis, treatment, and decision regarding revaccination. Patients who experience an allergic reaction with the first dose of covid 19 vaccine should be directed to the allergy-immunologist, and the evaluation of at-risk patients should be individualized. Finally, we should point out that the benefits of current COVID-19 vaccines go far beyond the side effects, and that the vaccine is the most important way to recover from the pandemic.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Algoritmos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Humanos
11.
Curr Allergy Asthma Rep ; 21(7): 41, 2021 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-34463914

RESUMO

PURPOSE OF REVIEW: Non-IgE-mediated drug reactions have traditionally been poorly defined and studied, though they are the most common form of hypersensitivity. Their presentations are highly variable and can range in severity from mild, cutaneous-only reactions to severe systemic disease. RECENT FINDINGS: The most notable advance in non-IgE-mediated hypersensitivity reactions is in diagnostics. HLA alleles have traditionally been used for identifying certain patients at risk for abacavir hypersensitivity syndrome, but more recent studies have shown several other HLA alleles associated with severe cutaneous adverse reactions with various medications. This article also highlights the use of delayed intradermal testing for radiocontrast media and patch testing for delayed antibiotic reactions. Drug reactions remain a major cause of morbidity and reason for treatment changes. Non-IgE-mediated reactions have had an increase in research interest over the past decade with an increased emphasis on better understanding the clinical presentation and underlying pathophysiology.


Assuntos
Hipersensibilidade a Drogas , Síndrome de Stevens-Johnson , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Humanos , Pele
12.
Front Immunol ; 12: 668962, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34385999

RESUMO

Neuromuscular blocking agents (NMBAs) like atracurium and rocuronium as well as fluoroquinolones (FQs) cause mast cell-mediated anaphylaxis by activating Mas-related G protein-coupled receptor X2 (MRGPRX2), but many questions remain unanswered. Here, we address three of them, namely whether primary human mast cells show similar activation by these drugs as murine mast cells and mast cell lines, how sugammadex protects from atracurium-induced MRGPRX2-mediated mast cell activation, and why some but not all patients treated with rocuronium develop anaphylaxis. We used peripheral blood-derived cultured mast cells from healthy donors and patients, assessed mast cell activation and degranulation by quantifying intracellular calcium and CD63 expression, respectively, and made use of MRGPRX2-silencing, via electroporation with Dicer-substrate small interfering RNAs, and single cell flow cytometric analyses. Atracurium, ciprofloxacin, and levofloxacin activated and degranulated primary human mast cells, but only MRGPRX2-positive and not MRGPRX2-negative or -silenced mast cells. Sugammadex attenuated the atracurium-induced and MRGPRX2-mediated activation and degranulation of human mast cells by reducing free atracurium levels. The mast cells of patients with IgE-independent anaphylaxis to rocuronium were similar, in their MRGPRX2 expression and function, to those of patients with IgE-mediated anaphylaxis. These findings further improve our understanding of the role and relevance of MRGPRX2-driven mast cell activation in anaphylactic reactions to NMBAs and FQs and may help to improve their prediction, prevention, and treatment.


Assuntos
Anafilaxia/induzido quimicamente , Antibacterianos/toxicidade , Degranulação Celular/efeitos dos fármacos , Hipersensibilidade a Drogas/etiologia , Mastócitos/efeitos dos fármacos , Proteínas do Tecido Nervoso/metabolismo , Fármacos Neuromusculares não Despolarizantes/toxicidade , Receptores Acoplados a Proteínas G/metabolismo , Receptores de Neuropeptídeos/metabolismo , Anafilaxia/imunologia , Anafilaxia/metabolismo , Atracúrio/toxicidade , Sinalização do Cálcio/efeitos dos fármacos , Células Cultivadas , Ciprofloxacina/toxicidade , Hipersensibilidade a Drogas/imunologia , Hipersensibilidade a Drogas/metabolismo , Humanos , Imunoglobulina E/imunologia , Levofloxacino/toxicidade , Mastócitos/imunologia , Mastócitos/metabolismo , Proteínas do Tecido Nervoso/genética , Receptores Acoplados a Proteínas G/genética , Receptores de Neuropeptídeos/genética , Rocurônio/toxicidade , Fatores de Tempo
13.
Pediatr Blood Cancer ; 68(11): e29295, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34398511

RESUMO

Vaccinationis a critical tool in the prevention of COVID-19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently, in North America, only the BNT162b2 (Pfizer-BioNTech) mRNA vaccine is approved for individuals aged 12-17. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive PEG-asparaginase (PEG-ASNase) and 10%-30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients is critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG-ASNase allergy.


Assuntos
Antineoplásicos/efeitos adversos , Asparaginase/efeitos adversos , Vacinas contra COVID-19/uso terapêutico , COVID-19/prevenção & controle , Hipersensibilidade a Drogas/complicações , Polietilenoglicóis/efeitos adversos , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Adolescente , Adulto , COVID-19/complicações , Vacinas contra COVID-19/administração & dosagem , Vacinas contra COVID-19/efeitos adversos , Criança , Hipersensibilidade a Drogas/etiologia , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adulto Jovem
15.
BMC Pediatr ; 21(1): 327, 2021 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315435

RESUMO

BACKGROUND: Infectious morbidity and mortality in the first week of life is commonly caused by early-onset neonatal Group B streptococcus (GBS) disease. This infection is spread from GBS positive mothers to neonates by vertical transmission during delivery and results in serious illness for newborns. Intrapartum prophylactic antibiotics have decreased the incidence of early-onset neonatal GBS disease by 80%. Patients labeled with a penicillin allergy (PcnA) alternatively receive either vancomycin or clindamycin but effectiveness is controversial. We evaluated the influence of a reported PcnA label versus no PcnA label on inpatient maternal and neonatal outcomes. METHODS: Our goal was to examine the relationship between a PcnA label, maternal and neonatal outcomes, and hospital costs. We collected retrospective data with institutional IRB approval from 2016 - 2018 for hospitalized patients who were GBS positive, pregnant at time of admission, ≥ 18 years of age, received antibiotic prophylaxis for GBS, were labeled as PcnA or non-PcnA, and completed a vaginal delivery. Patient characteristics and maternal/neonatal outcomes were examined. Statistical tests included calculations of means, medians, proportions, Mann-Whitney, two-sample t-tests, Chi-squared or Fisher's Exact tests, and generalized linear and logistic regression models. Significance was set at p < 0.05. RESULTS: Most PcnA patients were white, older, had a higher median body mass index and mean heart rate, and a greater proportion used tobacco than non-PcnA patients. In regression analyses, PcnA hospitalized patients received a shorter duration of antibiotic treatment than non-PcnA patients [incidence rate ratio (IRR): 0.45, 95% CI: 0.38-0.53]. PcnA patients were also more likely to have their baby's hospital LOS be > 48 h [adjusted odds ratio (AOR): 1.35, 95% CI: 1.07-1.69] even though the PcnA mothers' LOS was not different from non-PcnA mothers. Cost of care, mortality, intensive care, median parity, mean gravidity, and miscarriage were similar between the groups. CONCLUSIONS: In hospitalized obstetric patients, a PcnA label was associated with a shorter maternal course of antibiotic treatment and a longer neonatal LOS. Further prospective studies are needed to clarify the underlying reasons for these outcomes.


Assuntos
Hipersensibilidade a Drogas , Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Antibacterianos/efeitos adversos , Antibioticoprofilaxia , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mães , Penicilinas/efeitos adversos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Estudos Retrospectivos , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae
17.
BMJ Case Rep ; 14(7)2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34257106

RESUMO

Actinomycosis is a subacute-to-chronic bacterial infection caused by gram-positive, filamentous, non-acid-fast, facultative anaerobic bacteria. It is a normal commensal bacterium found in the oral cavity and the lower reproductive tract of women. We present a case of primary actinomycosis of the breast. A postmenopausal woman, complicated by penicillin allergy, presented with a left breast lump clinically simulating malignancy. The first line of treatment for actinomycosis is penicillin. Due to a penicillin allergy, the patient was initially treated with doxycycline. However, doxycycline was discontinued due to tremors, and was replaced by clindamycin. The patient had a good clinical response with resolution of the abscess.


Assuntos
Actinomicose , Hipersensibilidade a Drogas , Actinomicose/diagnóstico , Actinomicose/tratamento farmacológico , Antibacterianos/efeitos adversos , Clindamicina , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Feminino , Humanos , Penicilinas/efeitos adversos
19.
Curr Opin Allergy Clin Immunol ; 21(4): 401-409, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34091550

RESUMO

PURPOSE OF REVIEW: Whereas the COVID-19 pandemic has changed our lives worldwide, we hope that vaccination can combat the disease. We propose how to evaluate suspected severe allergic reactions to the vaccines so that as many as possible may be safely vaccinated. RECENT FINDINGS: Rare cases of severe allergic reactions after COVID-19 vaccination have been observed, seemingly at a higher frequency than for other vaccines. Few excipients are likely to have caused these reactions. IgE-mediated reactions to polyethylene glycol (PEG) and its derivatives are the most suspected, albeit hitherto unproven, causes. We suggest to make a diagnosis based on skin tests with PEG and PEG derivatives and that these be considered in relation to the decisions required before the first and the second vaccine dose. A vaccine without these excipients is available, but published data about its side effects are limited. SUMMARY: The underlying immunological mechanisms of the rare severe allergic reactions to the COVID-19 vaccines are poorly understood and need to be clarified. Identifying those who have an undiagnosed allergy to PEG and PEG derivatives is crucial before vaccination, and these substances are found in laxatives, cosmetics and in 30% of all our medications today.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19/prevenção & controle , Hipersensibilidade a Drogas/diagnóstico , Excipientes/efeitos adversos , Pandemias/prevenção & controle , COVID-19/epidemiologia , COVID-19/imunologia , COVID-19/virologia , Vacinas contra COVID-19/química , Vacinas contra COVID-19/imunologia , Tomada de Decisão Clínica , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Excipientes/administração & dosagem , Humanos , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , SARS-CoV-2/imunologia , Testes Cutâneos/normas , Vacinação/normas
20.
Rev Alerg Mex ; 68(1): 80-83, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34148331

RESUMO

BACKGROUND: Warfarin is an oral anticoagulant which is widely used in the prevention and treatment of thromboembolic events, to which multiple adverse effects are attributed; nevertheless, descriptions of hypersensitivity reactions to this medication are rare. CASE REPORT: A 59-year-old patient with a history of mesenteric thrombosis, who had previously received long-term treatment with warfarin. Upon discontinuation of the medication, the patient experienced a recurrence of thrombosis at a hepatosplenic level, with a subsequent hypersensitivity reaction upon administration of the coumarin. It was decided that treatment with warfarin should be continued as it was considered the best therapeutic option, which is why a rapid desensitization protocol was carried out. CONCLUSION: Hypersensitivity reactions to warfarin are rare; we propose the option of a desensitization protocol for patients who require this medication as long as the clinical benefit is considered greater than the reaction.


Assuntos
Hipersensibilidade a Drogas , Varfarina , Dessensibilização Imunológica , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Humanos , Pessoa de Meia-Idade , Varfarina/efeitos adversos
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