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1.
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
2.
Br J Anaesth ; 123(1): e144-e150, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30961915

RESUMO

BACKGROUND: Following diagnosis of neuromuscular blocking agent (NMBA) anaphylaxis, identifying safe alternatives for subsequent anaesthesia is critical. A patient with anaphylaxis to one NMBA can also have an allergic reaction to other NMBAs (cross-reactivity). Whilst drug provocation testing is standard for identifying or excluding allergy, there is significant risk. In vitro, after an allergen activates basophils, basophils express surface activation markers that can be measured by basophil activation testing (BAT). We compared cross-reactivity between NMBAs assessed by BAT against that by skin testing. METHODS: All patients attending an anaesthetic allergy clinic in Sydney, Australia between May 2017 and July 2018 diagnosed with NMBA anaphylaxis qualified for this study comparing intradermal skin tests and BAT with a panel of NMBAs (rocuronium, vecuronium, pancuronium, suxamethonium, cisatracurium). RESULTS: Of the 61 patients participating, sensitisation on skin testing and on BAT completely matched in only nine patients (15%). Sensitisation was not in agreement for pancuronium, cisatracurium and rocuronium, but was in agreement for vecuronium and suxamethonium. Nine patients with negative skin tests subsequently tolerated cisatracurium, and one false positive on BAT to cisatracurium was detected. CONCLUSIONS: The utility of BAT in identifying safe NMBAs for subsequent anaesthesia needs further evaluation. BAT detects a different cross-reactivity profile to skin tests. Negative skin testing and BAT might increase confidence in performing drug provocation testing, but this and follow-up of subsequent anaesthesia in our cohort is necessary to determine the clinical significance of BAT sensitisation.


Assuntos
Anafilaxia/imunologia , Basófilos/imunologia , Hipersensibilidade a Drogas/imunologia , Bloqueadores Neuromusculares/imunologia , Testes Cutâneos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Austrália , Reações Cruzadas/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Cutâneos/métodos , Adulto Jovem
3.
Pediatr Allergy Immunol ; 30(3): 325-334, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30734368

RESUMO

BACKGROUND: Pollen-related seasonal allergic rhinoconjunctivitis (SAR) is a very frequent pediatric disease in Westernized countries. Risk factors and disease phenotypes have been thoroughly examined in several cross-sectional studies. By contrast, only a few studies have examined disease evolution in patient cohorts. We investigated predictive biomarkers of disease evolution in a large cohort of children with SAR. METHODS: During 2015-2017 (follow-up), we re-examined 401 patients from those enrolled in 2009-2011 (baseline) by the "Panallergens in Pediatrics" study, a large multicenter survey of Italian children with SAR. Information on clinical history (standard questionnaire, AllergyCARD®; TPS, Italy) and skin prick tests for inhalant and foods extracts (ALK-Abelló, Hørsholm, Denmark) was acquired as at baseline visit. Evolution in clinical and sensitization data of patients was analyzed over time, as well as their association with the main baseline characteristics and atopy risk factors. RESULTS: The average age of participants was 10.4 ± 3.4 years at baseline and 16.2 ± 3.6 years at follow-up. SAR persisted in 93.3% of patients at follow-up and became more frequently associated with asthma (from 36.7% at baseline to 48.6% at follow-up) and oral allergy syndrome (OAS, from 23.4% to 37.7%). Compared to baseline, the prevalence of skin sensitization to some pollens (Phleum pratense, Corylus avellana, Platanus acerifolia, Artemisia vulgaris) and vegetables (hazelnut, wheat, and apple) significantly decreased at follow-up. Earlier onset of SAR and polysensitization at baseline were associated with incident asthma at follow-up. The presence at baseline of serum IgE to the following allergen molecules was identified as biomarkers of clinical evolution: (a) Phl p 1, for persistence of SAR; (b) Phl p 5, for persistence of both rhinitis and asthma; (c) Pru p 3, for new onset of asthma; (d) Bet v 1, for persistence of OAS. CONCLUSIONS: Seasonal allergic rhinoconjunctivitis is clinically heterogeneous in its evolution from childhood to adolescence. The detection of serum IgE to specific molecules (Phl p 1, Phl p 5, Bet v 1, Pru p 3) may be useful as biomarkers to predict SAR persistence and future onset of comorbidities, such as asthma and/or OAS.


Assuntos
Biomarcadores/sangue , Imunoglobulina E/sangue , Rinite Alérgica/sangue , Testes Cutâneos/métodos , Adolescente , Alérgenos/imunologia , Asma/epidemiologia , Asma/etiologia , Criança , Progressão da Doença , Feminino , Seguimentos , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Prevalência , Estudos Prospectivos , Rinite Alérgica/complicações , Rinite Alérgica/diagnóstico , Fatores de Risco , Testes Cutâneos/estatística & dados numéricos , Inquéritos e Questionários
4.
Pediatr Allergy Immunol ; 30(1): 93-98, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30298641

RESUMO

BACKGROUND: Insect venom is the second most common cause of anaphylaxis outside of medical encounters. Stings cause over 20% of all anaphylactic deaths and 7% of anaphylaxis in children. To date, there have been no longitudinal studies of insect sting events or allergy in preschool children. METHODS: A prospective longitudinal nested observational study in the BASELINE Birth Cohort Study (n = 2137). Sting-related questions were asked at 6 and 12 months and 2 and 5 years. Skin prick testing (SPT) was performed at 2 and 5 years. SpIgE testing was performed on selected cases at 2 years. RESULTS: Seventy-seven children (6.8%) were stung by the age of 2. Of these, 25 (32.5%) reported adverse reactions (four systemic). Eleven (0.9%) had positive SPT at 2 years (eight bee, two wasp, one both). Four stung children had positive SPT. Two (one stung, one never stung) had positive spIgE to a venom component at 2 years. A total of 268 children (21.9%) were stung by 5 years, 144 (52.1%) reporting local reactions and none systemic. Four children (0.4%) had positive SPT at 5 years: one bee and three wasp. Of the 11 SPT-positive children at 2 years, none were still positive at 5 years. CONCLUSION: This is the first longitudinal study of the natural history of hymenoptera stings and allergy in preschool children. Hymenoptera venom allergy is less common in this cohort than in adults. Systemic reactions were not medically documented in this population, in keeping with previous literature. This study confirms the poor correlation of IgE sensitization to venom with sting allergy and does not support the common parental request to screen children for sting allergy.


Assuntos
Himenópteros/imunologia , Hipersensibilidade/etiologia , Mordeduras e Picadas de Insetos/epidemiologia , Animais , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Hipersensibilidade/epidemiologia , Imunoglobulina E/sangue , Lactente , Mordeduras e Picadas de Insetos/imunologia , Irlanda/epidemiologia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Testes Cutâneos/estatística & dados numéricos , Inquéritos e Questionários
5.
Br J Clin Pharmacol ; 85(3): 492-500, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30521088

RESUMO

Antibiotic allergy labels (AALs) are reported by approximately 20% of hospitalized patients, yet over 85% will be negative on formal allergy testing. Hospitalized patients with an AAL have inferior patient outcomes, increased colonization with multidrug-resistant organisms and frequently receive inappropriate antimicrobials. Hospitalized populations have been well studied but, to date, the impact of AALs on patients with critical illness remains less well defined. We review the prevalence and impact of AALs on hospitalized patients, including those in in critical care.


Assuntos
Antibacterianos/efeitos adversos , Gestão de Antimicrobianos/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Hipersensibilidade a Drogas/diagnóstico , Fidelidade a Diretrizes/estatística & dados numéricos , Adulto , Gestão de Antimicrobianos/normas , Cuidados Críticos/normas , Estado Terminal , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prevalência , Autorrelato/estatística & dados numéricos , Testes Cutâneos/normas , Testes Cutâneos/estatística & dados numéricos
9.
J Coll Physicians Surg Pak ; 28(10): 766-771, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30266121

RESUMO

OBJECTIVE: To identify the common aeroallergens causing allergy symptoms among the allergic rhinitis patients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Immunology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from January to July 2016. METHODOLOGY: Patients with a clinical diagnosis of allergic rhinitis were enrolled. Skin Prick Test (SPT) was performed on these patients using 12 common aeroallergens along with positive (histamine hydrochloride, 10 mg/ml) and negative (glycerin saline) controls. Results were recorded after 15 minutes, considering a wheal diameter >3 mm as positive. Chi-square test was used to compare frequencies; and p-value of less than 0.05 was considered significant. RESULTS: Out of 130 patients, 78 (60%) were males and 52 (40%) were females. The rate of sensitization to any allergen was 90%. One hundred and two (78%) were poly-sensitized to more than two allergens and 20% were sensitized to more than six allergens. Most common outdoor and indoor allergens were Broussonetia papyrifera (50.7%) and Dermatophagoides farina (42.3%), respectively. Dog epithelia and aspergillus were the least prevalent allergens (13.8% each). CONCLUSION: This study highlighted an increased overall frequency of sensitization to any allergen and significance of tree and weed allergens; especially, Broussonetia papyrifera and Cannabis sativa. It also emphasized increased prevalence of skin reactivity to indoor allergen, Dermatophagoides farina in the city.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Alérgenos/efeitos adversos , Rinite Alérgica/epidemiologia , Testes Cutâneos/estatística & dados numéricos , Adulto , Poluentes Atmosféricos/imunologia , Alérgenos/imunologia , Animais , Broussonetia/imunologia , Estudos Transversais , Dermatophagoides farinae/imunologia , Dermatophagoides pteronyssinus/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prevalência , Rinite Alérgica/etiologia , Rinite Alérgica/imunologia
10.
Allergol. immunopatol ; 46(1): 3-8, ene.-feb. 2018. tab
Artigo em Inglês | IBECS | ID: ibc-170781

RESUMO

Background: Food protein-induced allergic proctocolitis is a frequent cause of rectal bleeding in infants. Characteristics of infants with multiple food allergies have not been defined. Objective: This study aimed to identify characteristics of infants with proctocolitis and compare infants with single and multiple food allergies. Methods: A total of 132 infants with proctocolitis were evaluated retrospectively. All of the infants were diagnosed by a paediatric allergist and/or a paediatric gastroenterologist according to guidelines. Clinical features of the infants, as well as results of a complete blood count, skin prick test, specific immunoglobulin E, and stool examinations or colonoscopy were recorded. Results: Cow's milk (97.7%) was the most common allergen, followed by egg (22%). Forty-five (34.1%) infants had allergies to more than one food. Infants with multiple food allergies had a higher eosinophil count (613 ± 631.2 vs. 375 ± 291.9) and a higher frequency of positive specific IgE and/or positive skin prick test results than that of patients with a single food allergy. Most of the patients whose symptoms persisted after two years of age had multiple food allergies. Conclusions: There is no difference in clinical presentations between infants with single and multiple food allergies. However, infants with multiple food allergies have a high blood total eosinophil count and are more likely to have a positive skin prick test and/or positive specific IgE results (AU)


No disponible


Assuntos
Humanos , Lactente , Proctocolite/etiologia , Hemorragia Gastrointestinal/etiologia , Hipersensibilidade Alimentar/complicações , Proteínas na Dieta/efeitos adversos , Colonoscopia , Eosinofilia/imunologia , Hipersensibilidade Imediata/imunologia , Testes Cutâneos/estatística & dados numéricos
11.
Allergol. immunopatol ; 46(1): 45-57, ene.-feb. 2018. tag
Artigo em Inglês | IBECS | ID: ibc-170787

RESUMO

Introduction: Food allergy refers to abnormal reactions of the body caused by an immune system response to food. This study was conducted aiming to investigate allergy to food allergens in children with food allergies. Materials and methods: This study was conducted as a cross-sectional one on 304 children aged six months to seven years with food allergies admitted to the tertiary referral hospital in Kurdistan Province - Iran, during 2014–2015. All the patients were examined for skin prick test using 49 allergens. Finally, the obtained data were analysed using SPSS15 and chi-square and t tests. Results: The highest percentage of occurrence of bump reaction (wheal) and redness (flare) was due to the consumption of fish, eggs, tomatoes, and cocoa. Moreover, the lowest rate of wheal and flare was caused by exposure to allergens like latex, tea, malt, and wheat flour. The reaction most created due to the consumption of foods was flare which was higher among under three-year-olds group (p < 0.05), and between the sexes, girls showed the most common allergic reactions (p < 0.05). Conclusion: Since food allergy has a high prevalence in children, it should be considered with great interest. Considering that avoiding food allergens is the first step in the treatment of food allergies, the present study may be a useful guide in this regard (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Hipersensibilidade Alimentar/epidemiologia , Testes Cutâneos/estatística & dados numéricos , Alérgenos/análise , Irã (Geográfico)/epidemiologia , Estudos Transversais , Fatores de Risco
12.
Actas dermo-sifiliogr. (Ed. impr.) ; 109(1): 58-62, ene.-feb. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-170872

RESUMO

Introducción: Pese al uso tan extendido de la Mercromina Film® y otros antisépticos de uso tópico, estos no se encuentran incluidos en la serie estándar española del Grupo Español de Investigación en Dermatitis de Contacto y Alergia Cutánea, realizada ante sospecha de dermatitis alérgica de contacto. Además, no existen estudios recientes sobre capacidad alergogénica de la merbromina, motivo por el que se plantea la presente investigación. Objetivo: Determinar la capacidad alergénica de la merbromina y compararla con la de los otros antisépticos de uso tópico frecuentemente utilizados en la práctica clínica, entre los que se incluye la povidona iodada, clorhexidina y eosina. Material y métodos: Estudio observacional de seguridad, prospectivo y unicéntrico realizado en 105 pacientes con sospecha de dermatitis alérgica de contacto que acudieron a la consulta del departamento de dermatología. Resultados: El 1,9% de los participantes presentó dermatitis alérgica de contacto a la merbromina. El 12,4% de los pacientes presentó sensibilización ante la povidona iodada. Las diferencias entre el porcentaje de pacientes que presentó dermatitis alérgica de contacto a Betadine (R) solución dérmica respecto al resto de antisépticos fueron estadísticamente significativas (prueba de McNemar; p < 0,05). No se registraron efectos adversos con ninguno de los antisépticos en estudio. Conclusiones: Mercromina Film ha demostrado una muy baja capacidad alergénica en la prueba de patch test. Cuando se comparan con otros antisépticos tópicos, la mayor capacidad alergénica se encontró con la povidona iodada (AU)


Introduction: Although Mercromina Film and other topical antiseptics are widely used, they are not included in the standard series recommended by the Spanish Contact Dermatitis and Skin Allergy Research Group for testing suspected allergic contact dermatitis (ACD). Furthermore, no recent studies have investigated the allergenic potential of merbromin. Objective: To determine the allergenic potential of merbromin and compare it with that of other topical antiseptics widely used in clinical practice, including povidone-iodine, chlorhexidine, and eosin. Material and methods. Prospective single-center observational safety study of 105 patients with suspected ACD seen at the dermatology department of our hospital. Results: Of the 105 patients studied, 1.9% had a positive patch test to merbromin and 12.4% were sensitized to povidone-iodine. The differences in the proportion of patients with ACD to Betadine Solución Dérmica (povidone-iodine) compared with the rest of the antiseptics was statistically significant (McNemar test, P < .05). No adverse reactions were observed in any of the patients. Conclusions: Based on the patch tests conducted, Mercromina Film has very low allergenic potential. The highest allergenic potential was observed for povidone-iodine (AU)


Assuntos
Humanos , Dermatite Alérgica de Contato/diagnóstico , Hipersensibilidade a Drogas/diagnóstico , Anti-Infecciosos Locais/efeitos adversos , Merbromina/farmacocinética , Estudos Prospectivos , Segurança do Paciente , Testes Cutâneos/estatística & dados numéricos , Dermatopatias Infecciosas/tratamento farmacológico , Testes do Emplastro/estatística & dados numéricos
13.
Ann Rheum Dis ; 77(4): 563-570, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29306872

RESUMO

OBJECTIVES: Our aim was to use the opportunity provided by the European Scleroderma Observational Study to (1) identify and describe those patients with early diffuse cutaneous systemic sclerosis (dcSSc) with progressive skin thickness, and (2) derive prediction models for progression over 12 months, to inform future randomised controlled trials (RCTs). METHODS: The modified Rodnan skin score (mRSS) was recorded every 3 months in 326 patients. 'Progressors' were defined as those experiencing a 5-unit and 25% increase in mRSS score over 12 months (±3 months). Logistic models were fitted to predict progression and, using receiver operating characteristic (ROC) curves, were compared on the basis of the area under curve (AUC), accuracy and positive predictive value (PPV). RESULTS: 66 patients (22.5%) progressed, 227 (77.5%) did not (33 could not have their status assessed due to insufficient data). Progressors had shorter disease duration (median 8.1 vs 12.6 months, P=0.001) and lower mRSS (median 19 vs 21 units, P=0.030) than non-progressors. Skin score was highest, and peaked earliest, in the anti-RNA polymerase III (Pol3+) subgroup (n=50). A first predictive model (including mRSS, duration of skin thickening and their interaction) had an accuracy of 60.9%, AUC of 0.666 and PPV of 33.8%. By adding a variable for Pol3 positivity, the model reached an accuracy of 71%, AUC of 0.711 and PPV of 41%. CONCLUSIONS: Two prediction models for progressive skin thickening were derived, for use both in clinical practice and for cohort enrichment in RCTs. These models will inform recruitment into the many clinical trials of dcSSc projected for the coming years. TRIAL REGISTRATION NUMBER: NCT02339441.


Assuntos
Esclerodermia Difusa/diagnóstico , Índice de Gravidade de Doença , Testes Cutâneos/estatística & dados numéricos , Adulto , Área Sob a Curva , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Modelos Logísticos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , RNA Polimerase III/análise , Curva ROC , Esclerodermia Difusa/enzimologia , Esclerodermia Difusa/patologia , Pele/patologia
15.
Ann Med ; 49(8): 710-717, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28844171

RESUMO

BACKGROUND: About 10% of subjects report suspected penicillin allergy, but 85-90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics Objective: To design and validate a clinical decision-making algorithm, based on anamnesis (chronology, severity, and duration of the suspected allergic reactions) and reaching a 100% sensitivity and negative predictive value, to assess allergy risk related to a penicillin prescription in general practise. STUDY DESIGN AND METHODS: All patients were included prospectively and explorated based on ENDA/EAACI recommendations. Results of penicillin allergy work-up (gold standard) were compared with results of the algorithm. RESULTS: Allergological work-up diagnosed penicillin hypersensitivity in 41/259 patients (15.8%) [95% CI: 11.5-20.3]. Three of these patients were diagnosed as having immediate-type hypersensitivity to penicillin, but had been misdiagnosed as low risk patients using the clinical algorithm. Thus, the sensitivity and negative predictive value of the algorithm were 92.7% [95% CI: 80.1-98.5] and 96.3% [95% CI: 89.6-99.2], respectively, and the probability that a patient with true penicillin allergy had been misclassified was 3.7% [95% CI: 0.8-10.4]. CONCLUSIONS: Although the risk of misclassification is low, we cannot recommend the use of this algorithm in general practice. However, the algorithm can be useful in emergency situations in hospital settings. Key messages True penicillin allergy is considerably lower than alleged penicillin allergy (15.8%; 41 of the 259 patients with suspected penicillin allergy). A clinical algorithm based on the patient's clinical history of the supposed allergic event to penicillin misclassified 3/41 (3.7%) truly allergic patients.


Assuntos
Algoritmos , Antibacterianos/efeitos adversos , Tomada de Decisão Clínica , Hipersensibilidade a Drogas/diagnóstico , Penicilinas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/imunologia , Criança , Feminino , Humanos , Masculino , Anamnese , Pessoa de Meia-Idade , Penicilinas/imunologia , Fatores de Risco , Sensibilidade e Especificidade , Testes Cutâneos/estatística & dados numéricos , Adulto Jovem
16.
Ann Allergy Asthma Immunol ; 119(3): 258-261, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28743423

RESUMO

BACKGROUND: Most patients with a history of penicillin allergy can tolerate penicillin. Skin testing can identify tolerant patients, but not all known allergenic determinants are commercially available. Protocols exist that use only available reagents, but the sensitivity and safety of these protocols, particularly for hospitalized patients, are controversial. OBJECTIVE: To determine the number of hospitalized patients referred for penicillin skin testing who showed unique positivity to the minor determinants penicilloate and penilloate. METHODS: A retrospective chart review was conducted of all inpatients who underwent penicillin skin testing at 1 institution. Patients were referred by their treating physician. All patients underwent skin prick testing to benzylpenicilloyl polylysine (major determinant), penicillin G, penicilloate, penilloate (minor determinants), amoxicillin, and positive and negative controls. If the result was negative, then intradermal testing was done with the same penicillin determinants and the negative control. A 4-mm wheal with flare was considered a positive reaction. RESULTS: Inpatient penicillin skin testing was done in 528 subjects. Any positive test reaction was found in 107 subjects (20%). Three subjects (3%) reacted to penilloate only, 25 (23%) reacted to penicilloate only, 2 (2%) reacted to penicillin G only, and 8 (8%) reacted to amoxicillin only. Sixty-eight subjects (64%) reacted to a compound other than the major determinant. CONCLUSION: This study found a high rate of exclusively positive skin test reactions to the minor determinants penicilloate and penilloate. Because patients with positive test reactions are at increased risk of reaction to drug challenge, these data support the use of these reagents for penicillin skin testing in hospitalized patients.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Penicilinas/efeitos adversos , Testes Cutâneos/estatística & dados numéricos , Humanos , Pacientes Internados
17.
Medicina (B Aires) ; 77(3): 180-184, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28643673

RESUMO

Drug hypersensitivity reactions (RHD) are those that present clinically as allergic. They can or cannot involve an immunologic mechanism of lesion. They are frequent and, occasionally, life threatening. Patients with RHD repeat the reaction when they are re-exposed to the drug, limiting the therapeutic options and exposing them to more expensive and toxic drugs. It is difficult to identify the responsible drug when the reaction was not recent or when it occurred in the context of therapy with multiple drugs or confusing concurrent diseases. The diagnosis should be based on clinical history, followed by drug skin tests and drug provocation tests. We describe our experience in 771 procedures, 331 cutaneous and 440 drug provocation tests, 11% of them were positive. Positive symptoms included generalized pruritus, rash, urticaria, angioedema, rhinitis, bronchospasm, nausea and anaphylaxis. All the patients with positive tests had a good response to treatment. It can therefore be concluded that drug tests undertaken on individuals with suspected drug allergy, performed by experienced personnel and in controlled settings, are useful and safe to confirm drug hypersensitivity.


Assuntos
Hipersensibilidade a Drogas/diagnóstico , Testes Cutâneos/métodos , Humanos , Testes Cutâneos/estatística & dados numéricos
19.
Turk J Med Sci ; 47(2): 577-582, 2017 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-28425249

RESUMO

BACKGROUND/AIM: Although the etiopathogeneses of psoriasis and atopy appear to be different, psoriasis has been found to be associated with atopy and atopic dermatitis. In this study, we aimed to determine the role of atopy by examining the medical history and clinical and laboratory findings of patients with psoriasis. MATERIALS AND METHODS: Patients with psoriasis, asthma patients, and healthy volunteers were included in the study. Serum total immunoglobulin E (IgE) levels were obtained, and prick tests were administered to all groups. RESULTS: Psoriatic patients demonstrated percentages of atopy history (21.3%) that were higher than those of the healthy subjects (15.7%). The median total IgE level in psoriatic patients was found to be statistically higher than that in the healthy control group (P > 0.05). With respect to mite positivity, there were statistically significant differences in the psoriatic (P < 0.05) and asthmatic groups (P < 0.001) when compared to the healthy control group. CONCLUSION: Our study is the first to use skin prick tests with psoriatic patients. Skin prick test sensitivity to mites increased in psoriatic patients, and we believe that this finding may be useful in protecting psoriatic patients from activation of psoriasis and in determining the appropriate treatment approach.


Assuntos
Dermatite Atópica , Imunoglobulina E/sangue , Psoríase , Testes Cutâneos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Asma/epidemiologia , Asma/imunologia , Estudos de Casos e Controles , Dermatite Atópica/epidemiologia , Dermatite Atópica/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psoríase/epidemiologia , Psoríase/imunologia , Adulto Jovem
20.
J Sports Med Phys Fitness ; 57(7-8): 1045-1050, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-26997323

RESUMO

BACKGROUND: Allergic rhinitis (AR) is a disease that reduces athletic performance. Environmental allergen exposure is higher in outdoor sports (such as orienteering) than indoor sports. The main purpose of this study was to investigate the AR frequency in orienteers comparing with indoor athletes. METHODS: Sixty adolescent athletes (33 orienteers, 27 basketball players) enrolled this prospective study. AR diagnosis was made by both history (ISAAC questionnaire) and physical examination. Nasal endoscopy was performed to observe objective findings (concha hypertrophy, mucosal paleness, serosity, septum deviation, adenoid hypertrophy). Epidermal prick test, pulmonary function test, total IgE and serum eosinophil levels were also assessed. RESULTS: AR was diagnosed in 21 (35%) athletes. 14 (42.4%) were orienteers and 7 (25.9%) were basketball players (P=0.144). Endoscopic findings and skin test positivity were also seen at higher percentages in orienteers with no significance. Training age (sport duration), total IgE levels and skin test positivity were significantly higher in rhinitic orieenters than non-rhinitic orieenters (P=0.046, P=0.0001, and P=0.004, respectively). CONCLUSIONS: Although adolescent orieenters had some higher allergic parameters than indoor athletes, they were not found more susceptible to AR. It seems that the frequency of AR increases with longer training age in orieentering sport. This study is the first report about AR in adolescent orienteers. Future researchs should more focus on comparing allergic conditions between outdoor and indoor sports.


Assuntos
Atletas , Rinite Alérgica/epidemiologia , Esportes , Adolescente , Atletas/estatística & dados numéricos , Desempenho Atlético/fisiologia , Basquetebol , Criança , Feminino , Humanos , Incidência , Masculino , Orientação Espacial/fisiologia , Estudos Prospectivos , Fatores de Risco , Testes Cutâneos/estatística & dados numéricos
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