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Allergy drug hypersensitivity

Katherine C Konvinse, Elizabeth J Phillips, Katie D White, Jason A Trubiano
PURPOSE OF REVIEW: Antimicrobials are a leading cause of severe T cell-mediated adverse drug reactions (ADRs). The purpose of this review is to address the current understanding of antimicrobial cross-reactivity and the ready availability of and evidence for in-vitro, in-vivo, and ex-vivo diagnostics for T cell-mediated ADRs. RECENT FINDINGS: Recent literature has evaluated the efficacy of traditional antibiotic allergy management, including patch testing, skin prick testing, intradermal testing, and oral challenge...
October 7, 2016: Current Opinion in Infectious Diseases
Tara F Carr
OBJECTIVE: The aim of this paper was to review the classification of adverse drug reactions, highlight the known pathophysiology of immediate hypersensitivity reactions, and discuss the utility of diagnostic testing for immunologically mediated immediate reactions to gadolinium-based contrast agents (GBCAs). METHODS: Current literature on immediate reactions to GBCA was reviewed and summarized. RESULTS: Adverse drug reactions to GBCA are rare, and can be attributed to physiologic, immunologic, and nonimmunologic processes...
June 29, 2016: Topics in Magnetic Resonance Imaging: TMRI
James R Costello, Bobby Kalb, Diego R Martin
Since their clinical introduction in 1988, gadolinium-based contrast agents (GBCAs) have demonstrated an excellent safety profile with a reported acute adverse reaction rate ranging from 0.01% to 2%. By comparison, the acute adverse reaction rate of low osmolar nonionic computed tomography contrast agents (CTCs) ranges from 0.7% to 3.1%. Many of the risk factors associated with CTC reactions (drug allergies, asthma, atopy, prior contrast reaction) also point toward an increased incidence of acute adverse events to GBCAs...
June 29, 2016: Topics in Magnetic Resonance Imaging: TMRI
G Cortellini, A Romano, A Santucci, A Barbaud, S Bavbek, D Bignardi, M Blanca, P Bonadonna, M T Costantino, J J Laguna, C Lombardo, L Losappio, J Makowska, A Nakonechna, O Quercia, E A Pastorello, V Patella, I Terreehorst, S Testi, J R Cernadas, J Dionicio Elera, D Lippolis, S Voltolini, D Grosseto
BACKGROUND: Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, the present study aims to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization. METHODS: Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel...
October 12, 2016: Allergy
Francesco Gaeta, Maria J Torres, Rocco Luigi Valluzzi, Cristiano Caruso, Cristobalina Mayorga, Antonino Romano
Hypersensitivity reactions to β-lactam antibiotics are commonly reported. They can be classified as immediate or non-immediate according to the time interval between the last drug administration and their onset. Immediate reactions occur within one hour after the last drug administration and are manifested clinically by urticaria and/or angioedema, rhinitis, bronchospasm, and anaphylactic shock; they may be mediated by specific IgE-antibodies. Non-immediate reactions occur more than one hour after the last drug administration...
October 4, 2016: Current Pharmaceutical Design
M Marcel Bergmann, Jean Christoph Caubet
Suspicion for drug hypersensitivity (DH) is a common reason for children's referral to an allergy department, with β-lactam antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs) as the most frequently involved drugs. The prevalence of DH in children remains not well defined as epidemiologic studies in children are lacking, and the most of those take into account adverse drug reactions without a systematic allergy work-up to confirm or exclude hypersensitivity. The clinical history is mandatory in order to classify the reaction as being immediate or non-immediate and then to subsequently adapt the allergy work-up...
September 26, 2016: Current Pharmaceutical Design
Marie Westwood, Bram Ramaekers, Shona Lang, Nigel Armstrong, Caro Noake, Shelley de Kock, Manuela Joore, Johan Severens, Jos Kleijnen
BACKGROUND: Allergy is a form of immune-mediated exaggerated sensitivity (hypersensitivity) to a substance that is either inhaled, swallowed, injected or comes into contact with the skin. Foreign substances that provoke allergies are called allergens. It has been claimed that multiplex allergen testing may help in diagnosing the cause of symptoms in patients with an unclear cause of allergy or who are allergic to more than one substance. OBJECTIVES: To evaluate multiplex allergen testing [devices that can measure the presence of multiple immunoglobulin E (IgE) antibodies in a patient's blood at the same time], by assessing (1) clinical effectiveness (allergy symptoms, incidence of acute exacerbations, mortality, adverse events of testing and treatment, health-care presentations or admissions, health-related quality of life); (2) effects on treatment (diet, immunotherapy medications, other potential testing); (3) any additional diagnostic information provided by multiplex allergen testing; and (4) cost-effectiveness (cost of different assessment strategies)...
September 2016: Health Technology Assessment: HTA
Daniel H Petroni, Moira L Aitken, Erin Ham, Sarah Chung, Lori Menalia, Matthew C Altman, Andrew G Ayars
BACKGROUND: Adverse drug reactions (ADRs) to antibiotics in patients with cystic fibrosis (CF) are common and often mislabeled as allergies. The labeling of an antibiotic reaction as an allergy can lead to the use of antibiotics that are less efficacious, are more expensive, or have a greater risk of adverse effects. OBJECTIVE: To establish a safe approach for the evaluation of ADRs to antibiotics in patients with CF to help clarify future use of these medications...
October 2016: Annals of Allergy, Asthma & Immunology
Bernardo Sousa-Pinto, Cláudia Correia, Lídia Gomes, Sara Gil-Mata, Luís Araújo, Osvaldo Correia, Luís Delgado
Delayed drug allergy reactions (DDAR) are potentially fatal. Certain human leukocyte antigen (HLA) alleles have been associated with delayed allergy reactions following the administration of particular drugs. Examples are HLA-B*57:01 (abacavir), HLA-B*15:02/HLA-A*31:01 (carbamazepine), and HLA-B*58:01 (allopurinol). Based on the identification of these associations, it may now be possible to prevent certain allergy reactions that were, until recently, considered unpredictable. In this review, we will focus on the pharmacogenetics of the best-studied associations between specific HLA alleles and delayed allergy reactions and describe the pathogenesis models proposed so far...
2016: International Archives of Allergy and Immunology
Trupti A Patel, Joanna Lukawska, Jennifer Rowe, Robin L Bailey
Praziquantel is the mainstay of treatment of Schistosomiasis, which affects at least 262 million people worldwide. It is also used in the treatment of other trematode as well as cestode infections, with few safe and effective alternatives. It is generally well tolerated and allergic reactions are rare. In this report, we present a case of schistosomiasis with a history of a hypersensitivity reaction to praziquantel. Skin-prick and intradermal testing were performed, followed by treatment through rapid desensitization...
August 29, 2016: American Journal of Tropical Medicine and Hygiene
Anca-Mirela Chiriac, Ticha Rerkpattanapipat, Philippe-Jean Bousquet, Nicolas Molinari, Pascal Demoly
BACKGROUND: Drug provocation tests (DPT) are commonly performed as part of ß-lactam allergy work-up, in case of negative skin tests, and in the absence of contraindications. The recommendations of learned societies have created a frame for DPT performance, but protocols vary widely between centres, generating various hypothesis-driven protocols (i.e., empirical dosing, driven by both safety concerns and practical aspects). METHODS: The primary objective of this retrospective analysis was to detect eliciting dose thresholds (reactive doses) during ß-lactam DPT, using the survival analysis method, in order to suggest optimal step doses...
August 29, 2016: Allergy
Noémie Scornet, Sandrine Delarue-Cochin, Marie-Eliane Azoury, Maxime Le Mignon, Julie-Anne Chemelle, Emmanuel Nony, Bernard Maillere, Raphael Terreux, Marc Pallardy, Delphine Joseph
β-Lactam antibiotics allergy is recognized as a public health concern. By covalently binding to serum proteins, penicillins are known to form immunogenic complexes. The latter are recognized and digested by antigen-presenting cells into drug-hapten peptides leading to the immunization of treated persons and IgE-mediated hypersensitivity reactions encompassing anaphylaxis. If type I allergic reactions to drugs are often unpredictable, they are known to be dependent on CD4+ T-cells. This fundamental study revisits the chemical basis of the benzylpenicillin (BP) allergy with the aim of identifying immunologically relevant biomimetic benzylpenicilloylated peptides through the analysis of BP-conjugated human serum albumin (BP-HSA) profile and the evaluation of the naïve CD4+ T-cell responses to candidate BP-HSA-derived peptides...
August 23, 2016: Bioconjugate Chemistry
N Ontiveros, E E Valdez-Meza, M J Vergara-Jiménez, A Canizalez-Román, A Borzutzky, F Cabrera-Chávez
BACKGROUND: Food allergy (FA) prevalence is well documented in developed countries and appears to be increasing, but remains unknown in most Latin American countries. We aimed to evaluate on a population basis the parent-reported prevalence of FA and its clinical characteristics in Mexican schoolchildren. METHODS: A validated Spanish version of a structured written questionnaire was administered to parents of schoolchildren aged 5-13 years old from Culiacan, Mexico...
July 27, 2016: Allergologia et Immunopathologia
C Alves, A M Romeira, C Abreu, P Carreiro-Martins, E Gomes, P Leiria-Pinto
INTRODUCTION: There are rather few publications about hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAID) in the paediatric age. In this study, we aimed to assess the frequency of confirmed NSAID hypersensitivity in children with a previous reported reaction to NSAID in order to investigate the role of the drug provocation test (DPT) in the diagnostic workup and to explore the factors associated with confirmed NSAID hypersensitivity. METHODS: We conducted a retrospective analysis of the clinical files from every patient under 18 years old who attended two Portuguese paediatric allergy outpatient clinics, from January 2009 to August 2014, due to a suspected NSAID hypersensitivity...
July 27, 2016: Allergologia et Immunopathologia
E Amsler, J-E Autegarden, P Senet, C Frances, A Soria
BACKGROUND: Iodinated contrast media (ICM) are used extensively by both radiologists and cardiologists. Injection of such products can induce immediate hypersensitivity reactions, some of which are IgE-mediated, and delayed hypersensitivity reaction with all types of drug eruptions being reported. Allergy tests, whether patch-tests or intradermal tests, are useful to confirm whether patients are allergic. At the end of these tests, depending on the reaction (chronology and clinical symptoms) and the results of the skin tests, patients are given an allergy card as well as a detailed certificate indicating the various ICM contraindicated and those allowed...
July 26, 2016: Annales de Dermatologie et de Vénéréologie
Sanjay Khandelwal, Gowthami M Arepally
The immune response to heparin is one of the most common drug-induced allergies, and yet, atypical for a drug hypersensitivity reaction. Whereas most drug-induced allergies are rare, idiosyncratic and life-long, the allergic response to heparin is common, predictable in certain clinical settings and transient. Advances in the last decade with regards to structural characterisation of the PF4/heparin antigenic complex, contributions of innate immunity and development of animal models have provided insights into the distinctive features of the HIT immune response...
July 28, 2016: Thrombosis and Haemostasis
Valentina Galbiati, Angela Papale, Elena Kummer, Emanuela Corsini
Hypersensitivity drug reactions (HDRs) are the adverse effect of pharmaceuticals that clinically resemble allergy. HDRs account for approximately 1/6 of drug-induced adverse effects, and include immune-mediated ("allergic") and non-immune-mediated ("pseudo allergic") reactions. In recent years, the severe and unpredicted drug adverse events clearly indicate that the immune system can be a critical target of drugs. Enhanced prediction in preclinical safety evaluation is, therefore, crucial. Nowadays, there are no validated in vitro or in vivo methods to screen the sensitizing potential of drugs in the pre-clinical phase...
2016: Frontiers in Pharmacology
Ana Rostaher, Natalie Hofer-Inteeworn, Claudia Kümmerle-Fraune, Nina Maria Fischer, Claude Favrot
BACKGROUND: Urticaria and anaphylaxis are frequently encountered in veterinary practice, but little is known about the causes and relative frequencies of these reactions. HYPOTHESIS/OBJECTIVES: This study was designed to improve current knowledge on the triggers, risk factors and clinico-pathological features of urticaria. ANIMALS: Twenty four dogs with signs of urticaria with or without anaphylaxis. METHODS: The study included dogs with cutaneous immediate-type hypersensitivity reactions...
July 18, 2016: Veterinary Dermatology
A Berti, E Della-Torre, Mr Yacoub, E Tombetti, V Canti, M G Sabbadini, G Colombo
BACKGROUND: The term "breakthrough reactions" designates repeated hypersensitivity reactions to iodinated contrast media (ICM) despite premedication with glucocorticoids and antihistamines. We aimed to retrospectively evaluate the rate of positive skin test (STs) in our cohort of patients with previous breakthrough reactions to different ICMs. METHODS: A series of 35 patients, who experienced at least one breakthrough reaction to ICM and who underwent STs within 6 months from the reaction were studied, and results were compared to a control group of patients with a first hypersensitivity reaction occurred without premedication...
July 2016: European Annals of Allergy and Clinical Immunology
Marina Atanaskovic-Markovic, Jean-Christoph Caubet
INTRODUCTION: Several recent studies confirmed that drug allergy in children is over diagnosed, which is a major public health problem, and results in use of alternative drugs, increasing resistance and health costs. AREAS COVERED: Articles in English with data on drug hypersensitivity in children were identified by searching the databases of MEDLINE (National Library of Medicine) from 1990 till 2016. Expert Commentary: It is crucial to make a precise diagnosis with performing a complete allergy work-up based on carefully selected diagnostic tests depending on whether an immediate or a non-immediate reaction is suspected...
July 15, 2016: Expert Review of Clinical Pharmacology
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