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Yeung WYW, Park HS. Update on the Management of Nonsteroidal Anti-Inflammatory Drug Hypersensitivity. Yonsei Med J 2020; 61:4-14. [PMID: 31887794 PMCID: PMC6938782 DOI: 10.3349/ymj.2020.61.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
The clinical phenotypes of nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity are heterogeneous with various presentations including time of symptom onset, organ involvements, and underlying pathophysiology. Having a correct diagnosis can be challenging. Understanding their respective mechanisms as well as developing a comprehensive classification and diagnostic algorithm are pivotal for appropriate management strategy. Treatment modalities are based on the subtypes and severity of hypersensitivity reactions. Insights into the phenotypes and endotypes of hypersensitivity reactions enable personalized management in patients with suboptimal control of disease. This review updated the recent evidence of pathophysiology, classification, diagnostic algorithm, and management of NSAID hypersensitivity reactions.
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Affiliation(s)
- Wan Yin Winnie Yeung
- Division of Rheumatology, Department of Internal Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
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Thong BYH, Lucas M, Kang HR, Chang YS, Li PH, Tang MM, Yun J, Fok JS, Kim BK, Nagao M, Rengganis I, Tsai YG, Chung WH, Yamaguchi M, Rerkpattanapipat T, Kamchaisatian W, Leung TF, Yoon HJ, Zhang L, Latiff AHA, Fujisawa T, Thien F, Castells MC, Demoly P, Wang JY, Pawankar R. Drug hypersensitivity reactions in Asia: regional issues and challenges. Asia Pac Allergy 2020; 10:e8. [PMID: 32099830 PMCID: PMC7016324 DOI: 10.5415/apallergy.2020.10.e8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
There are geographical, regional, and ethnic differences in the phenotypes and endotypes of patients with drug hypersensitivity reactions (DHRs) in different parts of the world. In Asia, aspects of drug hypersensitivity of regional importance include IgE-mediated allergies and T-cell-mediated reactions, including severe cutaneous adverse reactions (SCARs), to beta-lactam antibiotics, antituberculous drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) and radiocontrast agents. Delabeling of low-risk penicillin allergy using direct oral provocation tests without skin tests have been found to be useful where the drug plausibility of the index reaction is low. Genetic risk associations of relevance to Asia include human leucocyte antigen (HLA)-B*1502 with carbamazepine SCAR, and HLA-B*5801 with allopurinol SCAR in some Asian ethnic groups. There remains a lack of safe and accurate diagnostic tests for antituberculous drug allergy, other than relatively high-risk desensitization regimes to first-line antituberculous therapy. NSAID hypersensitivity is common among both adults and children in Asia, with regional differences in phenotype especially among adults. Low dose aspirin desensitization is an important therapeutic modality in individuals with cross-reactive NSAID hypersensitivity and coronary artery disease following percutaneous coronary intervention. Skin testing allows patients with radiocontrast media hypersensitivity to confirm the suspected agent and test for alternatives, especially when contrasted scans are needed for future monitoring of disease relapse or progression, especially cancers.
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Affiliation(s)
- Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Michaela Lucas
- Department of Immunology, Pathwest and Sir Charles Gairdner Hospital, Medical School, University of Western Australia, Perth, Australia
| | - Hye-Ryun Kang
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Department of Internal Medicine, Seoul National University College of Medicine, Drug Safety Center, Seoul National University Hospital, Seoul, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | | | - James Yun
- Faculty of Medicine and Health, The University of Sydney, Division of Medicine, Nepean Hospital, Sydney, Australia
| | - Jie Shen Fok
- Department of Respiratory Medicine, Box Hill Hospital, Eastern Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Byung-Keun Kim
- Department of Internal Medicine, Korea University Medical Center Anam Hospital, Seoul, Korea
| | - Mizuho Nagao
- Allergy Center of Mie National Hospital, Tsu, Japan
| | - Iris Rengganis
- Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Yi-Giien Tsai
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hung Chung
- Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung and Linkou Branches, College of Medicine, Chang Gung University, Taipei, Taiwan
| | - Masao Yamaguchi
- Division of Respiratory Medicine and Allergology, Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ticha Rerkpattanapipat
- Allergy, Immunology and Rheumatology Division, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Kamchaisatian
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Ratchathewi, Bangkok, Thailand
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing, China
| | | | | | - Francis Thien
- Eastern Health, Melbourne; Monash University, Melbourne, Australia
| | - Mariana C Castells
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Mastocytosis Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pascal Demoly
- Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, UPMC Univ Paris 06, UMRS 1136, Equipe - EPAR - IPLESP, Sorbonne Universités, Paris, France
| | - Jiu-Yao Wang
- Graduate Institute of Medical Sciences, China Medical University, Taichung, Taiwan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
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53
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Ali S, Corcea SL, Cristian RM, Bumbacea RS. A rapid desensitization protocol in a case of drotaverine-induced serum sickness-like reaction in a pregnant woman: A case report. Exp Ther Med 2019; 18:5105-5107. [PMID: 31819773 DOI: 10.3892/etm.2019.8170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 10/07/2019] [Indexed: 11/06/2022] Open
Abstract
Drotaverine is an antispasmodic drug used to treat gastrointestinal and genitourinary smooth muscle spasms. There are very few hypersensitivity reactions reported. Serum sickness-like disease is an immune-complex-mediated hypersensitivity reaction that presents with some typical features that include rash, fever and articular impairment sometimes associated with liver and renal dysfunctions, beginning 1-2 weeks after exposure to a culprit drug. Diagnosis is a clinical one, made usually on the basis of knowledge obtained by medical history and physical examination. Desensitization usually is recommended for type I reaction, but may be a solution for this type of immunological reaction when other therapeutic alternatives are ineffective or do not exist. We report the case of a 29-year-old pregnant female who developed serum sickness-like reaction after 5 days of daily drotaverine oral administration. The patient required antispasmodic treatment, with this drug, having a pregnancy with an imminent risk of abortion and the other therapeutic alternatives being ineffective. She underwent a rapid 7-step oral drotaverine desensitization protocol without recurrence of serum sickness-like reaction. To our knowledge, this is the first case report of desensitization to drotaverine, previously involved in a serum sickness-like reaction.
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Affiliation(s)
- Selda Ali
- Department of Allergy, 'Dr. Carol Davila' Nephrology Clinical Hospital, 010731 Bucharest, Romania.,Department of Allergy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sabina Loredana Corcea
- Department of Physiopathology and Immunology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Roxana Silvia Bumbacea
- Department of Allergy, 'Dr. Carol Davila' Nephrology Clinical Hospital, 010731 Bucharest, Romania.,Department of Allergy, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Diaferio L, Giovannini M, Clark E, Castagnoli R, Caimmi D. Protocols for drug allergy desensitization in children. Expert Rev Clin Immunol 2019; 16:91-100. [PMID: 31771366 DOI: 10.1080/1744666x.2019.1698294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: When a drug hypersensitivity reaction is proven, desensitization protocols allow the reintroduction of the molecule in patients for whom such therapy is essential. Through drug desensitization (DDS), a temporary immune tolerance is maintained for the single course of a specific therapy. In pediatrics, indications for such a procedure include children with chronic diseases, severe infectious diseases and/or malignancies, who have a proven drug hypersensitivity.Areas covered: We ran a search on PubMed and Web of Science for papers on DDS and on DDS in children. Most protocols and recommendations on DDS focus on adults and have been adapted for children. The best candidates for desensitization are children with a history of immediate, IgE-mediated drug allergy, but this therapy may be applied also in nonallergic hypersensitivities and in non-immediate reactions. Most protocols in literature focus on antibiotics, especially beta-lactams, on chemotherapeutic agents, and on monoclonal antibodies.Expert opinion: Pediatric allergists should cooperate with specialists in infectious diseases and onco-hematology to provide DDS to children in need. Standardized protocols and international guidelines are still needed to optimize such treatment and to implement it in clinical daily practice.
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Affiliation(s)
- Lucia Diaferio
- Department of Pediatrics, Aldo Moro University of Bari, Bari, Italy
| | - Mattia Giovannini
- Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, Florence, Italy
| | - Evangéline Clark
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France
| | | | - Davide Caimmi
- Allergy Unit, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Univ Montpellier, Montpellier, France.,Epidemiology of Allergic and Respiratory Diseases Department (EPAR), IPLESP, UMR 1136 INSERM - Sorbonne Université, Paris, France
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Pereira ARF, Aun MV, Kelmann NCP, Motta AA, Kalil J, Giavina-Bianchi P. Loss of tolerance 5 days after discontinuing sulphonamide introduced via desensitization in delayed reaction. EINSTEIN-SAO PAULO 2019; 18:eRC5002. [PMID: 31778467 PMCID: PMC6896605 DOI: 10.31744/einstein_journal/2020rc5002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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56
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Fowler T, Bansal AS, Lozsádi D. Risks and management of antiepileptic drug induced skin reactions in the adult out-patient setting. Seizure 2019; 72:61-70. [DOI: 10.1016/j.seizure.2019.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 12/22/2022] Open
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Ota T, Masuda N, Matsui K, Yamada T, Tanaka N, Fujimoto S, Fukuoka M. Successful Desensitization with Crizotinib after Crizotinib-induced Liver Injury in ROS1-rearranged Lung Adenocarcinoma. Intern Med 2019; 58:2651-2655. [PMID: 31178493 PMCID: PMC6794186 DOI: 10.2169/internalmedicine.2554-18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Crizotinib has been approved for patients with advanced lung adenocarcinoma harboring rearrangements of the c-ROS-1 (ROS1) and anaplastic lymphoma kinase (ALK) genes. We report a patient with ROS1-rearranged lung adenocarcinoma who developed a crizotinib-induced mixed/cholestatic type of liver injury. The patient discontinued crizotinib after 34 days due to liver toxicity. Twenty-four days later, when transaminases and C reactive protein (CRP) were normalized, crizotinib was resumed using an oral desensitization method. The patient was successfully treated for manageable recurrence of liver injury and has been able to continue the treatment.
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Affiliation(s)
- Takayo Ota
- Department of Medical Oncology, Izumi City General Hospital, Japan
| | - Noriyuki Masuda
- Department of Medical Oncology, Izumi City General Hospital, Japan
| | - Kaoru Matsui
- Department of Medical Oncology, Izumi City General Hospital, Japan
| | - Takao Yamada
- Department of Gastroenterology, Izumi City General Hospital, Japan
| | - Noriko Tanaka
- Department of Radiology, Izumi City General Hospital, Japan
| | | | - Masahiro Fukuoka
- Department of Medical Oncology, Izumi City General Hospital, Japan
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58
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Khan DA, Knowles SR, Shear NH. Sulfonamide Hypersensitivity: Fact and Fiction. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2116-2123. [DOI: 10.1016/j.jaip.2019.05.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/26/2019] [Accepted: 05/29/2019] [Indexed: 02/06/2023]
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59
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Chastain DB, Hutzley VJ, Parekh J, Alegro JVG. Antimicrobial Desensitization: A Review of Published Protocols. PHARMACY 2019; 7:E112. [PMID: 31405062 PMCID: PMC6789802 DOI: 10.3390/pharmacy7030112] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022] Open
Abstract
Antimicrobial desensitization represents a last-line option for patients with no alternative therapies, where the benefits of this intensive process must outweigh the potential harm from drug exposure. The goal of antimicrobial desensitization procedures is to establish a temporary state of tolerance to drugs that may otherwise cause hypersensitivity reactions. While no universal antimicrobial desensitization protocols exist, this review critically analyzes previously published desensitization protocols. The purpose of this review is to provide a greater insight for clinicians and institutions to ensure desensitization procedures are efficacious while minimizing potential for patient harm. With an increasing rate of antimicrobial resistance and the critical need to preserve antimicrobial agents, desensitization may represent another option in our antimicrobial stewardship toolkit.
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Affiliation(s)
| | | | - Jay Parekh
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA
| | - Jason Val G Alegro
- Mount Sinai Hospital, Chicago, IL 60608, USA.
- Roosevelt University College of Pharmacy, Schaumburg, IL 60173, USA.
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60
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Demir S, Gelincik A, Coskun R, Ozkan G, Demir N, Paksoy N, Beyaz S, Colakoglu B, Kalayoglu-Besisik S, Nalcacı M, Buyukozturk S. A practical 16-day desensitization protocol in lenalidomide-induced non-immediate hypersensitivity reactions. Ann Allergy Asthma Immunol 2019; 123:394-397. [PMID: 31400463 DOI: 10.1016/j.anai.2019.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Desensitization in immediate-type hypersensitivity reactions (HRs) caused by chemotherapeutics is well described and standardized for many drugs. However, there are no standardized protocols in non-immediate HRs. OBJECTIVE To evaluate the effectiveness of a 16-day desensitization protocol in the non-immediate HRs induced by lenalidomide. METHODS According to our previously published slow desensitization protocol, we desensitized patients who had experienced non-immediate HRs attributable to lenalidomide. The protocol was started with the 1/100 of the daily-prescribed dose in milligrams of the culprit drug; then the doses were slowly increased to complete the procedure in 16 days. Demographic and clinical features of the patients were further appraised. RESULTS Ten patients (mean age was 64.7 ± 10.8 years; 7 male) were successfully desensitized to lenalidomide. The mean reaction time was 7.3 ± 3.9 days in the history, and the reaction types were delayed urticaria (n = 4), eczematous rash (n = 3), and maculopapular eruptions (n = 3). The desensitization was successfully completed in 16 days in 9 patients. In 1 patient, maculopapular eruptions developed on the 11th day, and the patient was treated with corticosteroids. We repeated the previous tolerated dose longer and completed with a slower dose increasement, and the targeted dose was achieved in 35 days. CONCLUSION The 16-day desensitization protocol seemed to be safe and effective in the non-immediate type drug HRs caused by lenalidomide.
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Affiliation(s)
- Semra Demir
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey.
| | - Asli Gelincik
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Raif Coskun
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Gulkan Ozkan
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Nazli Demir
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Nail Paksoy
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Sengul Beyaz
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Bahauddin Colakoglu
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Sevgi Kalayoglu-Besisik
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Meliha Nalcacı
- Hematology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
| | - Suna Buyukozturk
- Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Turkey
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Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, Mahler V, Merk HF, Mülleneisen N, Ott H, Pfützner W, Röseler S, Ruëff F, Sitter H, Sunderkötter C, Trautmann A, Treudler R, Wedi B, Worm M, Brockow K. S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1876-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
PURPOSE OF REVIEW Immune-mediated adverse drug reactions (IM-ADRs) are many times more common in HIV-infected patients. Usual offending drugs include antiretroviral and antiinfectives, but the burden of specific drug IM-ADRs is population-specific; changing as new and fixed dose combinations enter the market, and drug-resistance patterns demand. This review considers recent literature on epidemiology, mechanisms, clinical management and prevention of IM-ADRs amongst persons living with HIV/AIDS. RECENT FINDINGS Epidemiological studies continue to describe high rates of delayed hypersensitivity to known offenders, as well as similar reactions in preexposure prophylaxis. IM-ADRs to oral and injectable integrase strand transfer inhibitors are reported with expanding use. The clinical spectrum and management of IM-ADRs occurring in HIV-infected populations is similar to uninfected; with exceptions such as a recently described severe delayed efavirenz DILI with high mortality. Furthermore, the context can be unique, such as the lower than expected mortality in a Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) cohort from a HIV/TB high burden setting. Programmatic data showing the near complete elimination of Abacavir drug hypersensitivity syndrome following implementation of HLA-B57:01 screening is a stellar example of how prevention is possible with mechanistic insight. SUMMARY IM-ADRs remain a challenge in persons living with HIV. The complexities posed by polypharmacy, overlapping drug toxicities, drug interactions, overlap of IM-ADRs with other diseases, limited alternative drugs, and vulnerable patients with advanced immunosuppression with high mortality, necessitate increased use of drug provocation testing, treat-through and desensitization strategies. There is an urgent need for improved diagnostics and predictive biomarkers for prevention, or to guide treat-through, rechallenge and desensitization approaches.
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Affiliation(s)
- Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
| | - Phuti Choshi
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Rannakoe J. Lehloenya
- Combined Drug Allergy Clinic, Groote Schuur Hospital, Cape Town, South Africa
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Yung CC, Watts TJ, Haque R. Successful desensitization to metronidazole in a patient with generalized fixed drug eruption. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:769-771.e1. [PMID: 31369825 DOI: 10.1016/j.jaip.2019.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Ching Ching Yung
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Timothy J Watts
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Rubaiyat Haque
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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64
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Mani R, Monteleone C, Schalock PC, Truong T, Zhang XB, Wagner ML. Rashes and other hypersensitivity reactions associated with antiepileptic drugs: A review of current literature. Seizure 2019; 71:270-278. [PMID: 31491658 DOI: 10.1016/j.seizure.2019.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 07/12/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
This article provides an overview of the pathogenesis and risk factors associated with antiepileptic drug (AED) hypersensitivity reactions, provides prescribing guidelines that may minimize the risk of antiepileptic induced rashes, and discusses treatment options for rashes. Articles indexed in PubMed, Science Citation, and Google Scholar (January 1946-March 2019) were systematic searched using the following key terms: hypersensitivity, rash, antiepileptic, epilepsy, cross-sensitivity, desensitization, patch testing and supplemented with our clinical experiences. Additional references were identified from a review of literature citations. AEDs are associated with cutaneous adverse reactions. Aromatic AEDs and higher titration rates are associated with increased risk of hypersensitivity reaction. Patient characteristics, underlying health conditions, and genetic variations may increase the likelihood of a hypersensitivity reaction. Once a hypersensitivity reaction occurs, the likelihood of cross sensitivity to another AED increases, especially among other aromatic AEDs. Withdrawal of the causal agent and initiation of a lower risk agent usually leads to resolution of symptoms. Desensitization protocols may be an option for patients whose seizures only respond to the AED causing the rash.
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Affiliation(s)
- Ram Mani
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Catherine Monteleone
- Division of Allergy, Immunology and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States.
| | - Peter C Schalock
- Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, United States.
| | - Thu Truong
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers the State University of New Jersey, Piscataway, NJ United States.
| | - Xiao B Zhang
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers the State University of New Jersey, Piscataway, NJ United States.
| | - Mary L Wagner
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers the State University of New Jersey, Piscataway, NJ United States.
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65
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Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40629-019-0100-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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66
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Yau P, Jimenez-Zepeda VH, Bailey K, Duggan P, Tay J, Bahlis NJ, Neri P, McCulloch S. Slow lenalidomide desensitization protocol for patients with multiple myeloma: case series from a single center. Leuk Lymphoma 2019; 60:3199-3203. [DOI: 10.1080/10428194.2019.1627537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Patrick Yau
- Department of Pharmacy, Tom Baker Cancer Center, Calgary, AB, Canada
| | | | - Kyla Bailey
- Department of Pharmacy, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Peter Duggan
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Jason Tay
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Nizar J. Bahlis
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Paola Neri
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
| | - Sylvia McCulloch
- Department of Medical Oncology and Hematology, Tom Baker Cancer Center, Calgary, AB, Canada
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Coster A, Aerts O, Herman A, Marot L, Horst N, Kenyon C, Vlieghe E, Hainaut P, Baeck M. Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome caused by first‐line antituberculosis drugs: Two case reports and a review of the literature. Contact Dermatitis 2019; 81:325-331. [DOI: 10.1111/cod.13296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 04/12/2019] [Accepted: 04/24/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Alison Coster
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
| | - Olivier Aerts
- Department of DermatologyUniversity Hospital Antwerp (UZA), and University of Antwerp (UA) Antwerp Belgium
| | - Anne Herman
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
| | - Liliane Marot
- Department of Anatomical PathologyCliniques universitaires Saint‐Luc Brussels Belgium
| | - Niels Horst
- Department of DermatologyUniversity Hospital Antwerp (UZA), and University of Antwerp (UA) Antwerp Belgium
| | - Chris Kenyon
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, and Unit of Tropical DiseasesUniversity Hospital of Antwerp (UZA) and University of Antwerp (UA) Antwerp Belgium
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, and Unit of Tropical DiseasesUniversity Hospital of Antwerp (UZA) and University of Antwerp (UA) Antwerp Belgium
| | - Philippe Hainaut
- Department of Internal MedicineCliniques universitaires Saint‐Luc Brussels Belgium
| | - Marie Baeck
- Department of DermatologyCliniques universitaires Saint‐Luc Brussels Belgium
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68
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Karaatmaca B, Aytac S, Sahiner UM, Sekerel BE, Soyer O. Successful oral desensitization with dasatinib in delayed cutaneous hypersensitivity reactions. Ann Allergy Asthma Immunol 2019; 123:216-217. [PMID: 31108179 DOI: 10.1016/j.anai.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Betul Karaatmaca
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Selin Aytac
- Department of Pediatric Hematology, Hacettepe University, School of Medicine, Ankara Turkey
| | - Umit Murat Sahiner
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Bulent Enis Sekerel
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University, School of Medicine, Ankara, Turkey.
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Anantharajah A, Lamproglou A, Bridle S, Chen W, Tong W. Successful cholecalciferol desensitisation in a case of delayed hypersensitivity. Asia Pac Allergy 2019; 9:e14. [PMID: 31089456 PMCID: PMC6494657 DOI: 10.5415/apallergy.2019.9.e14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022] Open
Abstract
Hypersensitivity to cholecalciferol (vitamin D3) or its active metabolite, calcitriol, is an exceedingly rare clinical phenomenon, with only 2 previously reported cases of suspected immediate hypersensitivity. Diagnosis of delayed drug hypersensitivity reactions is inherently difficult due to the lack of any robust in vitro diagnostic assay, particularly in those patients for whom provocation testing confers an unacceptable risk. In these situations, diagnosis relies on reproducible clinical manifestations following administration of the culprit agent, resolution upon its withdrawal and exclusion of other potential differential diagnoses. Based on these criteria, we propose the first reported case of delayed hypersensitivity to cholecalciferol successfully managed with a desensitisation protocol to pure cholecalciferol.
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Affiliation(s)
- Anthea Anantharajah
- Department of Immunology, The Canberra Hospital, Canberra, ACT 2606, Australia.,John Curtin School of Medical Research, Australian National University, Canberra, ACT 2601, Australia
| | - Anthony Lamproglou
- Department of Pharmacy, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Sylvia Bridle
- Department of Pharmacy, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
| | - Weiwen Chen
- Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
| | - Winnie Tong
- HIV, Immunology & Infectious Diseases Unit, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia.,Centre for Applied Medical Research, St Vincent's Hospital, Darlinghurst, NSW 2010, Australia
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70
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Kulhas Celik I, Dibek Misirlioglu E, Kocabas CN. Recent developments in drug hypersensitivity in children. Expert Rev Clin Immunol 2019; 15:723-733. [PMID: 31066307 DOI: 10.1080/1744666x.2019.1612241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: Drug allergy is an important public health problem that causes 0.4-10.3% of hospital admissions in children. The epidemiology, clinical spectrum, diagnosis, and management of drug hypersensitivity reactions (DHRs) differ in pediatric and adult patients. However, the same algorithms used in adults have often been applied in the pediatric population due to a lack of evidence in the literature. Areas covered: In this review, we aimed to discuss recent developments in the area of pediatric DHRs based on the growing body of literature advancing our understanding of the epidemiology, clinical aspects, and diagnostic approaches to DHRs in children. Expert opinion: Misdiagnosis, under-diagnosis, and self-diagnosis are common problems related to drug allergies in children. Viral infections are particularly frequent in children and make diagnosis difficult. Identifying true DHR is a key step in the management of drug allergy in children. Therefore, a complete allergy work-up with standardized drug allergy tests is necessary. In order to eliminate non-standardized tests, future studies including larger numbers of children should be conducted to determine more accurate standardized tests for diagnosing DHRs in the pediatric population.
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Affiliation(s)
- Ilknur Kulhas Celik
- a Division of Pediatric Allergy and Immunology , University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Emine Dibek Misirlioglu
- a Division of Pediatric Allergy and Immunology , University of Health Sciences, Ankara Child Health and Diseases Hematology Oncology Training and Research Hospital , Ankara , Turkey
| | - Can Naci Kocabas
- b Division of Pediatric Allergy and Immunology, Department of Children's Health and Diseases, Faculty of Medicine , Mugla Sitki Kocman University , Mugla , Turkey
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71
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Hong D, Sloane DE. Hypersensitivity to monoclonal antibodies used for cancer and inflammatory or connective tissue diseases. Ann Allergy Asthma Immunol 2019; 123:35-41. [PMID: 31028896 DOI: 10.1016/j.anai.2019.04.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To review the medical literature on hypersensitivity reactions to therapeutic monoclonal antibodies for patients with malignant tumors and chronic inflammatory or connective tissues diseases. DATA SOURCES We searched the PubMed database using the terms monoclonal antibody, hypersensitivity, and allergy. STUDY SELECTIONS We selected case reports and cohort studies of patients with hypersensitivity reactions to monoclonal antibodies. We included selected review articles to glean expert opinion on issues for which high-quality data are available. We sought specific information on the incidence, clinical description, pathobiology, and treatment of reactions. RESULTS Hypersensitivity reactions to therapeutic monoclonal antibodies can be classic type I (mast cell mediated, perhaps IgE dependent) reactions, cytokine release reactions, or type IV cell-mediated reactions. There are limited data on the frequency of such reactions, and because new agents are added to the set at a relatively high rate, it is difficult to determine precisely the incidence of reactions to this class of drugs as a whole. The classification of a specific hypersensitivity reaction depends mainly on the medical history. Skin testing may be available but often is not validated and may be prohibitively expensive. Avoidance of the culpable agent is ideal, but if treatment with the responsible drug is necessary, rapid drug desensitization is an option for type I reactions. Desensitization is less likely to be effective for cytokine release reactions and is contraindicated for type IV reactions. CONCLUSION Hypersensitivity reactions to therapeutic monoclonal antibodies are heterogeneous. Management depends on accurate identification and thoughtful consideration of the pathobiologic features of the reaction.
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Affiliation(s)
- David Hong
- Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts
| | - David E Sloane
- Department of Allergy and Immunology, Brigham and Women's Hospital, Boston, Massachusetts; Dana Farber Cancer Institute, Boston, Massachusetts.
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Abstract
PURPOSE OF REVIEW Tuberculosis (TB) is the commonest infectious cause of death globally. Adverse reactions to first-line tuberculosis antibiotics are common and have a major impact on the outcomes of patients as second-line antibiotics are less effective and more toxic. The present review addresses the most recent literature regarding epidemiology, investigating reactions, and reintroducing treatment in patients who have had their treatment interrupted. RECENT FINDINGS Studies have demonstrated that up to 60% of patients experience adverse reactions to TB treatment; around a third of these are idiosyncratic and may relate to immune sensitization. There is an increased risk in patients with HIV. For patients with severe cutaneous reactions patch testing has an important role; however, systemic reactions to patch testing are common in patients with HIV. In-vitro testing remains limited to specialist centers but studies have identified drug-specific lymphocyte responses in patients with cutaneous and liver reactions. Desensitization of patients with severe cutaneous reactions have been demonstrated to be possible, albeit at high risk. SUMMARY Management of these patients remains suboptimal. Better identification of predisposing factors, such as HLA alleles, are needed to identify patients at risk. Improved in-vitro diagnostics will reduce the need to re-expose the patient to the drug and optimized desensitization regimens will improve patient safety when drugs have to be re-introduced.
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73
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Chapman E, Leal D, Matijasevic E, García E. Desensitization in patients with hypersensitivity to haem arginate: A case report. World Allergy Organ J 2019; 12:100002. [PMID: 30937127 PMCID: PMC6439413 DOI: 10.1016/j.waojou.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/14/2018] [Accepted: 11/28/2018] [Indexed: 11/06/2022] Open
Abstract
Background Porphyria comprises a group of metabolic disorders caused by the irregular activities of enzymes within the haem biosynthetic pathway. This disease can provoke a large variety of symptoms. Acute porphyria attacks need to be treated urgently to avoid prolonged illness and fatal complications. Haem arginate, a concentrated haem solution stabilized with arginine, is the only preparation available for treatment in Europe and South America. This report describes a safe desensitization protocol for patients who require such treatment and have haem arginate hypersensitivity. Case presentation A 25-year-old female patient diagnosed with acute intermittent porphyria, who had an anaphylactic reaction while receiving haem arginate. The patient was treated with a desensitization protocol for patients with hypersensitivity to haem arginate. Conclusion Porphyria is a disease that can significantly compromise a patient's quality of life. The desensitization protocol for patients with hypersensitivity to haem arginate is a safe and effective treatment option for patients with a history of haem arginate allergies, to whom it is not possible to administer haematin.
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Affiliation(s)
- Edgardo Chapman
- Fundación Santa Fe de Bogotá, Carrera 7 N 117 - 15, Bogotá, Colombia
| | - Drixie Leal
- Fundación Santa Fe de Bogotá, Carrera 7 N 117 - 15, Bogotá, Colombia.,Facultad de Medicina, Universidad de los Andes, Carrera 7 N 116 - 15, Bogotá, Colombia
| | - Eugenio Matijasevic
- Fundación Santa Fe de Bogotá, Carrera 7 N 117 - 15, Bogotá, Colombia.,Facultad de Medicina, Universidad de los Andes, Carrera 7 N 116 - 15, Bogotá, Colombia
| | - Elizabeth García
- Fundación Santa Fe de Bogotá, Carrera 7 N 117 - 15, Bogotá, Colombia.,Facultad de Medicina, Universidad de los Andes, Carrera 7 N 116 - 15, Bogotá, Colombia
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74
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Watts TJ. Investigating Nonimmediate Drug Eruptions: Diagnostic Benefit of a Structured Approach. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1324-1326. [DOI: 10.1016/j.jaip.2018.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 11/25/2022]
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Gan H, Wang L, Fu W, Zhang J, Yu M, Liu G. Rapid subcutaneous desensitization for the management of delayed hypersensitivity reactions to omalizumab:A case report. J Clin Pharm Ther 2019; 44:486-488. [PMID: 30859588 DOI: 10.1111/jcpt.12827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 01/28/2019] [Accepted: 02/10/2019] [Indexed: 12/29/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Omalizumab is effective as an add-on drug to treat severe persistent allergic asthma. However, delayed hypersensitivity reactions to omalizumab may deprive patients of its use. Rapid subcutaneous desensitization could be a solution. CASE DESCRIPTION A 61-year-old man developed a delayed allergy to omalizumab after the first injection. A 14-step desensitization procedure was applied to the patient and was successful. WHAT IS NEW AND CONCLUSION Delayed hypersensitivity reactions to omalizumab are rare, but they may cause the interruption of drug usage. Desensitization to omalizumab could be a possible solution.
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Affiliation(s)
- Hui Gan
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ling Wang
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Fu
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinjin Zhang
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mingxia Yu
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guanghui Liu
- Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan, China
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76
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Abstract
PURPOSE OF REVIEW Pediatric drug hypersensitivity is a rapidly evolving field. The purpose of this paper is to review the current state of pediatric drug hypersensitivity and highlight new developments in diagnosis and management. RECENT FINDINGS This paper will discuss the safety and use of risk stratification to proceed directly to oral challenge without prior skin testing for β-lactam reactions. We review unique aspects of pediatric drug challenges and desensitizations. It is important to accurately diagnose pediatric drug hypersensitivity reactions through a detailed history, physical examination, and available diagnostic testing. Understanding of the underlying mechanism leads to appropriate classification which is necessary to direct management. The decision to perform drug challenge, desensitization, or recommend avoidance of a medication can have a significant impact on a patient's treatment. Utilization of weight-based dose and infusion rate adjustments for current drug challenge and desensitization protocols optimize success.
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77
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Caimmi S, Caffarelli C, Saretta F, Liotti L, Crisafulli G, Cardinale F, Bottau P, Mori F, Franceschini F, Bernardini R, Marseglia GL. Drug desensitization in allergic children. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:20-29. [PMID: 30830058 PMCID: PMC6502172 DOI: 10.23750/abm.v90i3-s.8158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 11/25/2022]
Abstract
Drug allergy is an increasing problem worldwide, affecting all populations and races, children and adults, and for which diagnosis and treatment are not well standardized yet. Besides classical treatments, new drugs have been developed, especially for patients suffering from malignancies and chronic inflammatory diseases, that specifically target the cause of the disease. For those patients requiring such molecules, it is sometimes difficult to find an alternative drug when hypersensitivity reactions occur. Desensitization is therefore the best option whenever no alternative therapy is available but also when alternative treatments are considered therapeutically inferior and or more toxic. Despite its clinical success, little is known about the mechanisms and molecular targets of drug desensitization. Desensitization protocols use a gradual dose escalation to allow the safe administration of a treatment to which a patient previously presented a hypersensitivity reaction. The procedure requires special training and coordination of an allergy team, including physicians, nurses, and pharmacists, working together to safely and successfully implement desensitization protocols when appropriate. There is no difference in desensitization protocol between adults and children, except for the final cumulative dose of the administered drug.
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Affiliation(s)
- Silvia Caimmi
- Pediatric Clinic, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
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Gelincik A, Demir S, Şen F, Bozbey UH, Olgaç M, Ünal D, Çolakoğlu B, Aktaş EÇ, Deniz G, Büyüköztürk S. Interleukin-10 is increased in successful drug desensitization regardless of the hypersensitivity reaction type. Asia Pac Allergy 2019; 9:e9. [PMID: 30740357 PMCID: PMC6365657 DOI: 10.5415/apallergy.2019.9.e9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/12/2018] [Indexed: 12/30/2022] Open
Abstract
Background Little is known about the mechanism of desensitization in hypersensitivity drug reactions. Objective The aim of this study was to evaluate the effects of drug desensitization on some cytokine levels in patients desensitized for drug hypersensitivity reactions. Methods Patients with a hypersensitivity reaction to any drug for whom desensitization was planned with the culprit drug, patients who could tolerate the same drugs and healthy subjects who were not exposed to these drugs were enrolled. Bead-based Milliplex MAP multiplex technology was used to determine interleukin (IL)-4, IL-5, interferon-γ and IL-10 levels in the sera of the subjects as a baseline and 24 hours after desensitization had been completed in the patients. Results A total of 26 patients (16 female [61.5%]; mean age 48.46 ± 15.97 years old), 10 control patients (5 female [50%]; mean age 47.4 ± 15.4 years old) and 5 healthy subjects (3 female [60%]; mean age 34.2 ± 5.6 years old) were enrolled. Four of the 26 patients did not tolerate the procedure and were grouped as the 'unsuccessful desensitization group' whereas 22 patients successfully completed the procedure and formed the 'successful desensitization group.' Baseline cytokine levels in the 3 groups were not statistically different. Postdesensitization IL-10 levels in the successful desensitization group were significantly higher than their initial levels (p = 0.005) whereas none of the cytokine levels significantly changed in the unsuccessful desensitization group. The rise in IL-10 levels was greater in chemotherapeutic desensitizations when compared to other drugs (p = 0.006). Conclusion Successful desensitization independent of the hypersensitivity reaction type seems to be related to the increase of IL-10.
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Affiliation(s)
- Aslı Gelincik
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Semra Demir
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fatma Şen
- Institute of Oncology, Istanbul University, Istanbul, Turkey
| | | | - Müge Olgaç
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Derya Ünal
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahauddin Çolakoğlu
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Esin Çetin Aktaş
- Department of Immunology, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Günnur Deniz
- Department of Immunology, Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Büyüköztürk
- Division of Immunology and Allergy, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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79
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Ban GY, Jeong YJ, Lee SH, Shin SS, Shin YS, Park HS, Kim SH, Ye YM. Efficacy and tolerability of desensitization in the treatment of delayed drug hypersensitivities to anti-tuberculosis medications. Respir Med 2019; 147:44-50. [PMID: 30704698 DOI: 10.1016/j.rmed.2018.12.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/11/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Delayed drug hypersensitivity to first-line anti-tuberculosis medication is a major challenge in tuberculosis treatment. OBJECTIVE This study was performed to investigate the efficacy/tolerability of desensitization therapy in treatment of first-line anti-tuberculosis medication hypersensitivity and the usefulness of immunologic evaluation therein. METHODS This study was conducted as a prospective, observational cohort study. Subjects who experienced hypersensitivity reactions, including maculopapular exanthema (MPE) and drug reaction with eosinophilia and systemic symptoms (DRESS), to first-line anti-tuberculosis medications (isoniazid [INH], ethambutol [EMB], rifampin [RFP], and pyrazinamide [PZA]) were enrolled. Patch, intradermal, lymphocyte transformation, and oral provocation tests were performed to determine culprit drugs, which were desensitized with rapid and graded challenge protocols. Breakthrough reactions (BTRs) during or after desensitization were assessed. RESULTS In total, 31 desensitization treatments (INH, 8; EMB, 8; RFP, 11; PZA, 4) to 12 patients (8 with MPE and 4 with DRESS) were performed. The overall success rate of desensitization was 80.7%. All the study subjects except one completed the full course of anti-tuberculosis treatment. The overall BTR free rate was 64.5%. Sixteen (80%) treatments for MPE and four (36.4%) for DRESS were BTR free (P = 0.023). Drugs that were positive on any two of three immunologic studies showed significantly high BTR rates (P = 0.014), although this was not correlated with desensitization failure rate. CONCLUSION Rapid desensitization therapy to multiple anti-tuberculosis medications for delayed drug hypersensitivity was safe and successful. Combination of multiple immunologic evaluations may predict BTR although it needs validation in larger studies.
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Affiliation(s)
- Ga-Young Ban
- Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, 05355, Republic of Korea
| | - Yoon-Jeong Jeong
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - So-Hee Lee
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Seung-Soo Shin
- Department of Pulmonology and Critical Care Medicine, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Yoo-Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea
| | - Seung-Hyun Kim
- Translational Research Laboratory for Inflammatory Disease, Clinical Trial Center, Ajou University Medical Center, Suwon, 16499, Republic of Korea.
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, 16499, Republic of Korea.
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80
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Delayed hypersensitivity skin reaction to hydroxychloroquine: Successful short desensitization. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:307-308. [DOI: 10.1016/j.jaip.2018.04.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/24/2018] [Accepted: 04/26/2018] [Indexed: 11/20/2022]
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81
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Roy M, Ahmad S, Roy AK. Successful rapid oral desensitization for dual hypersensitivity to isoniazid and rifampin while treating central nervous system tuberculosis. J Community Hosp Intern Med Perspect 2018; 8:345-348. [PMID: 30559942 PMCID: PMC6292347 DOI: 10.1080/20009666.2018.1545516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis of the central nervous system (CNS-TB) is a critical disease with poor prognosis if not diagnosed and treated early. A regimen of drugs with good CNS penetration is required for treatment. Treatment options are limited in case of hypersensitivity reaction of the recommended regimen. We are reporting a rare instance where a patient developed hypersensitivity to both first line agents (isoniazid and rifampin) for CNS-TB and was successfully desensitized against both these medications to complete the treatment course using the rapid desensitization process. There have been reported cases of desensitization to anti tuberculous medications in cases with pulmonary tuberculosis and hypersensitivity reaction. In this review article we discuss the prior used methods of slow and rapid desensitization in case on non-CNS tuberculosis infections. This is the first reported case to use similar method of rapid desensitization in treatment of central nervous system infection.
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Affiliation(s)
- Moni Roy
- Adult Hospitalist, OSF Saint Francis Medical Center, Peoria, IL, USA
| | - Sharjeel Ahmad
- Section of Infectious Diseases, Department of Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Ashish Kumar Roy
- Adult Hospitalist, OSF Saint Francis Medical Center, Peoria, IL, USA
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82
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Allergie aux antibiotiques dans la mucoviscidose : cohorte rétrospective des patients adultes suivis au centre de ressources et de compétences pour la mucoviscidose d’Angers et revue de la littérature. REVUE FRANCAISE D ALLERGOLOGIE 2018. [DOI: 10.1016/j.reval.2018.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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83
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Hypersensitivity Reactions to Antiepileptic Drugs in Children: Epidemiologic, Pathogenetic, Clinical, and Diagnostic Aspects. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1879-1891.e1. [DOI: 10.1016/j.jaip.2018.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/17/2018] [Accepted: 07/04/2018] [Indexed: 01/15/2023]
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84
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Calogiuri G, Mandurino-Mirizzi A, Parlangeli C, Macchia L, Foti C, Savage MP. Comparing Allergist and Cardiologist Considerations for the Optimal Management of Thienopyridines Hypersensitivity. Endocr Metab Immune Disord Drug Targets 2018; 19:2-12. [PMID: 30215337 DOI: 10.2174/1871530318666180914121758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 04/30/2018] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE The thienopyridine family includes ticlopidine, clopidogrel and prasugrel which are antiplatelet drugs largely used, mainly associated to aspirin, for treatment of acute coronary syndromes and after percutaneous coronary interventions, to avoid thrombosis. In some patients, thienpyridines may cause hypersensitivity reactions which jeopardize the optimal therapeutic and preventive approach to vascular diseases. The management of thienopyridine hypersensitivity seems to be best done as an interdisciplinary collaboration between the allergist and cardiologist. METHOD The present study investigates the management of thienopyridines hypersensitivity on the basis of published case reports and studies, comparing the pro and contro of pharmacological treatments, different desensitization protocols to thienopyridines and substitution of antiplatelet agents eaches others, according to the point of view of cardiologist and allergist. For the cardiologist, the important issues are the necessity of continuing therapy, the desired duration of therapy based on the clinical indication of the individual patient and appropriateness of using one of the alternative P2Y12 inhibitors. For the allergist, the important issues are weighing the risk and benefits of the various therapeutic options: treating "through" desensitization, or switching to an alternative agent. RESULTS AND CONCLUSION All the data seem to suggest that only working together, a cardio-allergy team of specialists may evaluate and offer the best approach to clinical decision-making for the individual patient.
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Affiliation(s)
- Gianfanco Calogiuri
- Pneumology and Allergy Department - Civil Hospital "Sacro Cuore" Gallipoli, Lecce, Italy.,Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Claudio Parlangeli
- Cardiology Intensive Care Unit - Civil Hospital San Giuseppe da Copertino - Copertino Lecce, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | - Caterina Foti
- Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, 70124 Bari, Italy
| | - Michael P Savage
- Department of Medicine, Jefferson Angioplasty Center, Thomas Jefferson University Hospital, Philadelphia, United States
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85
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Jimenez RB, Vera DG, Rivera-Díaz R, Cortijo-Cascajares S, Ballesteros RM, Pastor MDCD. Successful subcutaneous desensitization in a patient with allergy to ixekizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1761-1762. [DOI: 10.1016/j.jaip.2017.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/20/2017] [Accepted: 12/27/2017] [Indexed: 11/16/2022]
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86
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Borgemeester RWK, van Laar T, Schuttelaar MLA. Cutaneous adverse drug reaction after apomorphine infusion, possibly caused by a systemic type IV hypersensitivity reaction to sodium metabisulfite: Report of 2 cases. Contact Dermatitis 2018; 79:316-318. [DOI: 10.1111/cod.13058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Robbert W. K. Borgemeester
- Parkinson Expertise Centre; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
| | - Teus van Laar
- Parkinson Expertise Centre; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
| | - Marie L. A. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; Groningen The Netherlands
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87
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Collado-Chagoya R, Hernández-Romero J, Eliosa-Alvarado GA, Cruz-Pantoja RA, Campos-Gutiérrez RI, Velasco-Medina AA, Velázquez-Sámano G. Tolerance Induction to Antituberculosis Drugs in a Patient With Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap. ALLERGY & RHINOLOGY 2018; 9:2152656718783618. [PMID: 30083412 PMCID: PMC6071158 DOI: 10.1177/2152656718783618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tolerance induction and desensitization in Stevens-Johnson syndrome (SJS) or in toxic epidermal necrolysis (TEN) have been described as an absolute contraindication by some authors, but there are cases where there is no treatment alternative. Tuberculosis (TB) remains a leading cause of morbidity and mortality in developing countries and ranks alongside HIV as a leading cause of death worldwide. Severe drug reactions, such as SJS and TEN, occurring in these individuals are lifethreatening. Since alternative therapies for TB are limited, the role of desensitization and reintroduction becomes essential. We describe a case of tolerance induction to anti-TB drugs in a patient with SJS/TEN overlap syndrome using a specifically designed premedication, comedication, and desensitization protocol.
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Affiliation(s)
- Rodrigo Collado-Chagoya
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Javier Hernández-Romero
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Gumaro A Eliosa-Alvarado
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rubén A Cruz-Pantoja
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Rosa I Campos-Gutiérrez
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Andrea A Velasco-Medina
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Guillermo Velázquez-Sámano
- Allergy and Clinical Immunology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
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88
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Abstract
PURPOSE OF REVIEW We sought to review past and current literature on sulfonamide drug allergy and distill it in a practical manner to assist the clinician, specifically focusing on cross-reactivity and desensitization. RECENT FINDINGS There do not appear to be consistent genetic markers to reliably predict features of or the presence hypersensitivity reactions. Recent evidence continues to alleviate early concerns cross-reactivity between sulfonamide antibiotics and non-antibiotics. Sulfonamide drug allergy is frequently encountered by the practicing clinician. For sulfonamide antibiotics, delayed rash is the most common clinical manifestation. There is no current evidence to support avoidance of all non-antibiotic sulfonamides in those with a reported allergy to sulfonamide antibiotics, although certain scenarios require caution. Available evidence supports the cautious reintroduction of sulfonamide antibiotics via desensitization, which is usually well tolerated and should be considered in those with strong indications for trimethoprim-sulfamethoxazole and a reported sulfonamide allergy.
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Affiliation(s)
- Joshua M Dorn
- Mayo Clinic, Division of Allergic Diseases, 200 First Street SW, Rochester, MN, 55905, USA
| | - Mollie Alpern
- Mayo Clinic, Division of Allergic Diseases, 200 First Street SW, Rochester, MN, 55905, USA
| | - Caitlin McNulty
- Mayo Clinic, Division of Allergic Diseases, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gerald W Volcheck
- Mayo Clinic, Division of Allergic Diseases, 200 First Street SW, Rochester, MN, 55905, USA.
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89
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Successful oral desensitization with osimertinib following osimertinib-induced fever and hepatotoxicity: a case report. Invest New Drugs 2018; 36:952-954. [DOI: 10.1007/s10637-018-0608-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
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90
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Norton AE, Konvinse K, Phillips EJ, Broyles AD. Antibiotic Allergy in Pediatrics. Pediatrics 2018; 141:peds.2017-2497. [PMID: 29700201 PMCID: PMC5914499 DOI: 10.1542/peds.2017-2497] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/11/2022] Open
Abstract
The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.
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Affiliation(s)
- Allison Eaddy Norton
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and
| | - Katherine Konvinse
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Elizabeth J. Phillips
- Division of Allergy, Immunology and Pulmonology, Monroe Carell Jr. Children's Hospital at Vanderbilt, and,John A. Oates Institute for Experimental Therapeutics and Department of Pharmacology, School of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee;,Division of Infectious Disease, Departments of Medicine and,Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee;,Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia; and
| | - Ana Dioun Broyles
- Division of Allergy and Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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91
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Hanna C, Villa D, Irani C, Ghosn M, El Rassy E. Leukocytoclastic Vasculitis and Desensitization to High-dose Methotrexate in Primary Central Nervous System Lymphoma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2018; 18:e197-e200. [PMID: 29605422 DOI: 10.1016/j.clml.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Colette Hanna
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Diego Villa
- Division of Medical Oncology, BC Cancer - Vancouver, and Centre for Lymphoid Cancer, Vancouver, BC, Canada
| | - Carla Irani
- Department of Internal Medicine, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Elie El Rassy
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
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92
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Rosa JS, Vuong VB, Haskin O, Liu AY. A novel outpatient desensitization protocol for recombinant human erythropoietin allergy in a pediatric patient. Allergy Asthma Clin Immunol 2018; 14:8. [PMID: 29545827 PMCID: PMC5846227 DOI: 10.1186/s13223-018-0233-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 01/25/2018] [Indexed: 01/22/2023] Open
Abstract
Background Recombinant human erythropoietin, such as epoetin alfa and darbepoetin alfa, is an important therapy for anemia due to chronic renal failure. Allergy to recombinant human erythropoietin and the need for desensitization are rare. Case presentation We report here a novel epoetin alfa outpatient desensitization protocol in a girl who developed delayed cutaneous hypersensitivity to subcutaneous epoetin alfa and intravenous darbepoetin alfa. An initial attempt at traditional epoetin alfa desensitization failed, so we created a slower 17-day outpatient desensitization that succeeded and allowed treatment continuation. Conclusions This case highlights the notion that delayed-type hypersensitivity to recombinant human erythropoietin can occur as evident by reproducible reactions after repeated exposures and slow outpatient desensitization can be considered when a trial of more rapid induction of tolerance is unsuccessful.
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Affiliation(s)
- Jaime S Rosa
- 1Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305 USA.,Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, CA 94304 USA
| | - Van B Vuong
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, CA 94304 USA
| | - Orly Haskin
- Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, CA 94304 USA.,3Division of Nephrology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Anne Y Liu
- 1Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, 269 Campus Drive, CCSR 3215, MC 5366, Stanford, CA 94305 USA.,Lucile Packard Children's Hospital Stanford, Stanford Children's Health, Palo Alto, CA 94304 USA
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93
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How to Manage Antibiotic Allergy in Cystic Fibrosis? Epidemiologic, Diagnostic, and Therapeutic Aspects. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0152-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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94
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Siripassorn K, Ruxrungtham K, Manosuthi W. Successful drug desensitization in patients with delayed-type allergic reactions to anti-tuberculosis drugs. Int J Infect Dis 2018; 68:61-68. [PMID: 29410254 DOI: 10.1016/j.ijid.2018.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/07/2017] [Accepted: 01/11/2018] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To evaluate the outcomes of anti-tuberculosis drug desensitization. METHODS This was a retrospective study. Inclusion criteria were as follows: age >18years, documented tuberculosis infection, a previous cutaneous allergic reaction to anti-tuberculosis drugs, and having undergone drug desensitization between January 2003 and March 2014. The definition of allergic reaction to anti-tuberculosis drugs included (1) a temporal relationship between drug use and the allergic reaction; (2) improvement in the allergic reaction after drug withdrawal; (3) recurrence of the allergic reaction after reintroduction of only the offending drug; and (4) absence of other causes. RESULTS A total of 19 desensitization procedures were performed. The drugs used for these procedures were isoniazid (n=7), rifampicin (n=6), or ethambutol (n=6). Of note, severe allergic reactions (Stevens-Johnson syndrome (n=4), erythema multiforme (n=3), and drug rash with eosinophilia and systemic syndrome (n=1)) were included. All patients underwent resolution of the previous allergic reactions before desensitization. The median duration of desensitization was 18 days. The success rate was 78.9%. The allergic reactions following failed desensitization were not severe; most were maculopapular rashes. CONCLUSIONS The desensitization protocol for anti-tuberculosis drugs was associated with a high success rate, and the individuals who failed desensitization experienced mild allergic reactions.
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Affiliation(s)
| | - Kiat Ruxrungtham
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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95
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Heo YJ, Park SW, Lee KS, Kang HR, Kwon JW. Successful desensitization to fluconazole induced delayed hypersensitivity: A case report. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.1.68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Yeon-Jeong Heo
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Seung-Woo Park
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Kyu-Sun Lee
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
- Department of Allergy and Clinical Immunology, Kangwon National University Hospital, Chuncheon, Korea
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96
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Desensitization to protein kinase inhibitors: A systematic review. Ann Allergy Asthma Immunol 2017; 119:9-15. [PMID: 28668246 DOI: 10.1016/j.anai.2017.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/10/2017] [Accepted: 05/10/2017] [Indexed: 11/21/2022]
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97
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Brandt O, Bircher AJ. Spättypreaktionen auf oral und parenteral verabreichte Arzneimittel. J Dtsch Dermatol Ges 2017. [DOI: 10.1111/ddg.13362_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Oliver Brandt
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
| | - Andreas J. Bircher
- Allergologische Poliklinik; Dermatologische Klinik; Universitätsspital Basel; Schweiz
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98
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Brandt O, Bircher AJ. Delayed-type hypersensitivity to oral and parenteral drugs. J Dtsch Dermatol Ges 2017; 15:1111-1132. [PMID: 29106000 DOI: 10.1111/ddg.13362] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 09/07/2017] [Indexed: 01/22/2023]
Abstract
Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life-threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed-type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections.
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Affiliation(s)
- Oliver Brandt
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
| | - Andreas J Bircher
- Allergy Unit, Department of Dermatology, Basel University Hospital, Basel, Switzerland
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99
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Tal Y, Maoz Segal R, Langevitz P, Kivity S, Darnizki Z, Agmon-Levin N. Hydroxychloroquine desensitization, an effective method to overcome hypersensitivity—a multicenter experience. Lupus 2017; 27:703-707. [DOI: 10.1177/0961203317735185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Y Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - R Maoz Segal
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - P Langevitz
- The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Kivity
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Internal Medicine A, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
| | - Z Darnizki
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - N Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Unit, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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100
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McNulty CMG, Park MA. Delayed Cutaneous Hypersensitivity Reactions to Antibiotics: Management with Desensitization. Immunol Allergy Clin North Am 2017; 37:751-760. [PMID: 28965638 DOI: 10.1016/j.iac.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Successful desensitization to mild to moderate delayed cutaneous adverse reaction to antibiotics has been described in a limited number of antibiotics and found to be safe. However, there are ample opportunities to standardize protocols for delayed cutaneous adverse reactions to antibiotics.
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Affiliation(s)
- Caitlin M G McNulty
- Division of Allergic Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
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