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Wöhrl S, Ostermayer C, Sesztak-Greinecker G, Jarisch R, Hemmer W, Wantke F. Drug-specific history, skin and in vitro tests can reduce the need for drug provocation tests in betalactam-hypersensitivity. Allergol Int 2021; 70:244-251. [PMID: 33191122 DOI: 10.1016/j.alit.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/17/2020] [Accepted: 09/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Many patients report questionable drug hypersensitivity reactions (DHR) to betalactam antibiotics. A workup is required for objectivation. Direct drug provocation tests (DPTs) omitting a prior allergy workup are increasingly recommended as the primary diagnostic approach. However, apart from the risk of severe side effects, DPTs often are a scarce resource in overloaded healthcare-systems. We investigated how many cases can be solved by drug-specific history, drug-specific IgE, and skin tests obviating the need for DPT. METHODS We conducted a chart review in a retrospective cohort of 932 patients in an allergy outpatient centre from 2016 to 2017. Patients had been submitted to drug-specific history and specific IgE-, skin prick-, intradermal- and patch-tests with early and late readings with a series of penicillins and cephalosporins but DPTs were no option. RESULTS Overall, positive in vitro and/or skin tests were found in 96/932 (10.3%) patients. Drug-specific IgE was detected in 40/932 (4.3%) patients, 61/787 (7.8%) patients had positive skin tests. In vitro tests to Pencillin V showed the highest rate of positivity 24/479 (5.0%) and early readings of ampicillin the highest amongst the skin tests (3/49, 6.1%). Immediate skin tests were more often positive than delayed ones (75:45). The combination of all parameters including drug-specific history solved 346/932 (37.1%) cases while 586/932 (62.9%) remained unresolved. Self-reported DHR could be less often confirmed in females and young children (p < 0.05). CONCLUSIONS Testing with betalactams applying simple, cheap, and safe skin and blood tests can solve a third of DHR-cases on a high throughput scale.
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Coric A, Grgic S, Kostic S, Vukojevic K, Zovko R, Radica N, Markotic F. Attitudes of dental practitioners towards antimicrobial therapy in Croatia and Bosnia and Herzegovina. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:88-94. [PMID: 31574199 DOI: 10.1111/eje.12471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The objective of this study was to assess perceptions and attitudes amongst dental practitioners in relation to antibiotic usage and antibiotic resistance. METHODS Self-administered questionnaire was given to dental practitioners employed in south Croatia, west Herzegovina and Sarajevo, Bosnia and Herzegovina (N = 115). RESULTS 81.7% of respondents agreed the usage of antimicrobials is frequently uncritical and unnecessary. 83.5% of dental practitioners reported that they have used guidelines in their practice; however, only 9 out of 115 stated valid guidelines. One-third of the respondents agreed or were undecided that the usage of antimicrobials in every oral inflammatory process treatment is justified. Furthermore, 13% was undecided and 26% agreed that pregnant women and breastfeeding women should not use any antimicrobials. However, three quarters of respondents considered they had satisfactory knowledge on antimicrobials. DISCUSSION The respondents considered they had satisfactory knowledge on antimicrobials, which was in contrast to the knowledge shown, but also expressed the need for additional education. Therefore, adequate measures include the creation of the local guidelines, their implementation, and updating the practitioners' knowledge on antibiotic use and resistance through continuous educational courses.
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Affiliation(s)
- Anka Coric
- Health Care Centre Mostar, Mostar, Bosnia and Herzegovina
| | - Svjetlana Grgic
- Department for Infective Diseases, University Hospital Center Mostar, Mostar, Bosnia and Herzegovina
| | - Sandra Kostic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
- Department of Histology and Embryology, University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina
| | - Katarina Vukojevic
- Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Split, Croatia
- Department of Histology and Embryology, University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina
| | - Ruzica Zovko
- Health Care Centre Mostar, Mostar, Bosnia and Herzegovina
| | | | - Filipa Markotic
- Centre for Clinical Pharmacology, University Hospital Centre Mostar, Mostar, Bosnia and Herzegovina
- Department for Assessment of Safety and Efficacy, Croatian Agency for Medicinal Products and Medical Devices, Zagreb, Croatia
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Ibrahim NK, Alghamdi AA, Almehmadi MM, Alzahrani AA, Turkistani AK, Alghamdi K. Allergy and related clinical symptoms among medical students and interns. Pak J Med Sci 2019; 35:1060-1065. [PMID: 31372143 PMCID: PMC6659050 DOI: 10.12669/pjms.35.4.1281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To determine the prevalence, types, clinical presentations, triggers, and predictors of allergic disorders among medical students and interns at King Abdulaziz University (KAU), Jeddah, Saudi Arabia. METHODS A cross-sectional design was used for this study in which 600 medical students and interns were selected by a multistage stratified random sampling. A validated, confidential, self-administered questionnaire was used during 2016 / 2017. It asked about the previous diagnosis of allergic disorders, associated factors, types, clinical symptoms and the triggering allergenic. Descriptive & inferential statistics were done and logistic regression analysis was conducted. RESULTS The overall prevalence of diagnosed allergic disorder(s) among the participants was 36.2%.The commonest types of allergy were skin (33.8%) followed by respiratory (29.5%) presentations. The most frequently reported allergenic triggers were the house dust (45.6%) and smoke (30.4%). The first allergy predictor was family history of allergic disorders (aOR= 4.35, 95 % CI: 2.96-6.39), followed by female gender. Regarding the outcome of allergy on students' life, 16.1% occasionally missed classes, and 28.6% had sleep disturbance during allergic attacks. CONCLUSION Allergy represents an important problem among medical students and interns. Family history and female gender were the predictors of allergy. Skin and respiratory allergies were the most common types. House dust and smoke were the commonest allergenic triggers. Detection of allergens and management of cases of allergy among medical students and interns are needed. Education and conduction of awareness campaigns about allergy are needed.
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Affiliation(s)
- Nahla Khamis Ibrahim
- Nahla Khamis Ibrahim, Professor at Community Medicine Department, King Abdulaziz University, Jeddah, Saudi Arabia; Professor at Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Abeer Ali Alghamdi
- Abeer Ali Alghamdi, Medical Intern, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mayar Majed Almehmadi
- Mayar Majed Almehmadi, Medical Intern, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Asraa Khairallah Turkistani
- Asraa Khairallah Turkistani, Demonstrator of Family and Community Medicine, Umm Al Qura University, Mecca, Saudi Arabia
| | - Khalid Alghamdi
- Khalid Alghamdi, Resident, King Abdulaziz University, Jeddah, Saudi Arabia
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Kvedariene V, Sitkauskiene B, Tamasauskiene L, Rudzeviciene O, Kasiulevicius V, Nekrosyte G, Gomes E, Demoly P. Prevalence of self-reported drug hypersensitivity reactions among Lithuanian children and adults. Allergol Immunopathol (Madr) 2019; 47:32-37. [PMID: 30245285 DOI: 10.1016/j.aller.2018.05.006] [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] [Received: 01/11/2018] [Revised: 04/25/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Drug hypersensitivity reactions (DHRs) are the adverse effects of drugs that, when taken at doses generally tolerated by normal subjects, clinically resemble allergy. We aimed to assess the prevalence of self-reported DHRs among Lithuanian children and adults and to identify possible risk factors. MATERIALS AND METHODS A cross-sectional survey of a population visiting their general practitioners in Vilnius and Kaunas regions of Lithuania was performed. Thirty-five questions on drug allergy symptoms, in addition, food, pollen allergy and family history were included. RESULTS 3222 (60.0%) children and 2148 (40.0%) adults were included in the study. 7.9% of children and 13.8% of adults reported a DHR for at least one drug (p<0.001). 69.8% of children and 47.3% of adults, who indicated DHRs, had skin symptoms. Rate of anaphylaxis was similar in both groups (about 10%). 4.5% of children and 7.3% of adults had DHRs induced by antibiotics and this was the most implicated group of drugs. Significant self-reported risk factors for DHRs were family history of DHRs (OR=6.007, 95%CI 4.756-7.587), pollen allergy (OR=2.0, 95%CI 1.573-2.544), food allergy (OR=1.92, 95%CI 1.505-2.448), female gender (OR=1.439, 95%CI 1.187-1.744) and age (OR=1.017 in favour of adults, 95%CI 1.013-1.021). CONCLUSIONS The prevalence of self-reported DHRs in Lithuania is higher among adults than children. Drug-induced skin reactions were the predominant symptom in both groups. Besides female gender and age, a positive family history of DHR and presence of pollen or food allergy may be associated with DHR.
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Sousa-Pinto B, Fonseca JA, Gomes ER. Frequency of self-reported drug allergy: A systematic review and meta-analysis with meta-regression. Ann Allergy Asthma Immunol 2017; 119:362-373.e2. [PMID: 28779998 DOI: 10.1016/j.anai.2017.07.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/03/2017] [Accepted: 07/05/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients reporting drug allergy are treated with second-line therapies, with possible negative clinical and health consequences. OBJECTIVE To assess the prevalence of self-reported drug allergy. METHODS We performed a systematic review of observational studies assessing the prevalence of self-reported drug allergy. We searched 4 electronic databases. From selected studies, we extracted data on self-reported drug allergy prevalence, study design, participants' demographic characteristics, reported clinical manifestations, and suspected culprit drugs. We performed a random-effects meta-analysis followed by a meta-regression. RESULTS Fifty-three studies were included in the systematic review, assessing a total of 126,306 participants, of whom 8.3% (range across studies 0.7-38.5%) self-reported drug allergy. Cutaneous manifestations were reported by 68.2% of participants, and anaphylactic or systemic reactions were reported by 10.8%. Antibiotics, nonsteroidal anti-inflammatory drugs, and anesthetics were the most frequently reported culprit drug classes. The frequency of self-reported drug allergy was higher in female (11.4%) than in male (7.2%) patients, adults (10.0%) than in children (5.1%), and in studies in the medical setting (15.9% in inpatients, 11.4% in outpatients) than in the general population (5.9%). The meta-analysis rendered a pooled prevalence of 7.9% (95% confidence interval 6.4-9.6), and the meta-regression identified study region, participants' age group, and study setting as factors associated with significant heterogeneity. Confirmation tests (including skin, in vitro, and drug provocation tests) were performed in only 3 studies. CONCLUSION The prevalence of self-reported drug allergy is highly variable and is higher in female patients, adults, and inpatients. To overcome this variability, further studies using confirmation tests are needed.
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Affiliation(s)
- Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida Fonseca
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal; CINTESIS-Center for Health Technology and Services Research, Porto, Portugal
| | - Eva Rebelo Gomes
- Immunoallergology Department, Centro Hospitalar do Porto EPE, Porto, Portugal.
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Bedolla-Barajas M, Puente-Fernández C, Flores-Merino MV, Morales-Romero J, Domínguez-García MV. Self-report prevalence and associated factors to drug hypersensitivity in Mexican young adults. Asia Pac Allergy 2017; 7:156-162. [PMID: 28765820 PMCID: PMC5537080 DOI: 10.5415/apallergy.2017.7.3.156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/19/2017] [Indexed: 11/18/2022] Open
Abstract
Background Drug hypersensitivity is defined as any unfavorable reaction that occurs after the administration of any drug. It may or may not be mediated by the involvement of the immune system. Epidemiological data related to drug hypersensitivity reactions in our country are scarce. Objective To determine the prevalence of drug hypersensitivity in a group of young adults, as well as to identify associated factors. Methods A structured questionnaire was applied to young people aged 18 to 25 years. The instrument was oriented to identify reactions of drug hypersensitivity, as well as the most prevalent drugs involved. In addition, a personal and family history of atopic diseases was included. Analysis for associations between variables was been done through logistic regression. Results The prevalence of drug hypersensitivity reactions was 12% (144 of 1,200). The antibiotics were the agents most related to hypersensitivity reactions (9.8%) followed by nonsteroidal anti-inflammatory drugs (1.6%). Factors associated with drug hypersensitivity were a personal history of asthma, odds ratio (OR) 3.15 (95% confidence interval [CI], 1.44–6.91), maternal and paternal history of drug hypersensitivity, OR 2.33 (95% CI, 1.21–4.48) and OR 3.11 (95% CI, 1.22–7.92), respectively. Conclusion The results of this research show that drug hypersensitivity in young adults is a highly prevalent event and it is associated with personal history of asthma and history of drug hypersensitivity in parents.
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Affiliation(s)
- Martín Bedolla-Barajas
- Servicio de Alergia e Inmunología Clínica, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", 44340 Guadalajara, México
| | - Cecilia Puente-Fernández
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
| | - Miriam V Flores-Merino
- Centro de Investigación en Ciencias Médicas, Universidad Autónoma del Estado de México, Toluca, México
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Jannic A, Servy A, Chevalier X, Colin A, Chosidow O, Ingen-Housz-Oro S, Wolkenstein P. Self-diagnosed drug allergies: the belief of patients. J Eur Acad Dermatol Venereol 2017; 31:e524-e526. [DOI: 10.1111/jdv.14392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A. Jannic
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
| | - A. Servy
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
| | - X. Chevalier
- Rheumatology Department; AP-HP; Henri Mondor Hospital; Créteil France
- UPEC Université Paris-Est Créteil; Créteil France
| | - A. Colin
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
| | - O. Chosidow
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
- UPEC Université Paris-Est Créteil; Créteil France
- EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques); UPEC; Créteil France
| | - S. Ingen-Housz-Oro
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
- EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques); UPEC; Créteil France
| | - P. Wolkenstein
- Dermatology Department; AP-HP; Henri Mondor Hospital; Créteil France
- UPEC Université Paris-Est Créteil; Créteil France
- EA 7379 EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques); UPEC; Créteil France
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Turkish version of the Drug Hypersensitivity Quality of Life Questionnaire: assessment of reliability and validity. Qual Life Res 2015; 25:101-9. [PMID: 26091583 DOI: 10.1007/s11136-015-1051-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The first disease-specific quality-of-life questionnaire in patients with drug hypersensitivity, Drug Hypersensitivity Quality of Life Questionnaire (DrHy-Q), was developed and validated recently. The aim of this study was to assess validity, reliability and responsiveness to interventions of the Turkish version of the DrHy-Q. METHODS The Turkish version of the DrHy-Q was administered to prospectively enrolled 736 patients with drug hypersensitivity from ten allergy units. To assess validity, all patients completed the validated Turkish version of Psychological General Well-Being Index (PGWBI). For test-retest reliability, 182 patients completed the DrHy-Q 1 week after the first questionnaire administration without any intervention. Responsiveness was assessed on 97 patients who had a DrHy-Q recorded at a follow-up visit after the intervention. RESULTS The internal consistency and test-retest reliability of the scale were adequate (Cronbach's alpha = 0.934, intra-class correlation coefficient = 0.783). The DrHy-Q scores showed weak negative correlations with the PGWBI total and domain scores (r = - 0.378 to -0.254, p < 0.001). DrHy-Q was able to discriminate the patients with one drug hypersensitivity reaction from the patients with two and above two reactions (p = 0.012 and p < 0.001, respectively), and the patients who experienced a respiratory reaction from the patients who did not (p = 0.018). However, it did not discriminate the patients with comorbid disease including psychiatric comorbidity (p > 0.05). The baseline DrHy-Q scores were significantly higher than the post-intervention scores (p = 0.008). CONCLUSION The Turkish version of DrHy-Q is reliable and valid for evaluating quality of life in patients with drug hypersensitivity, and it appeared responsive to interventions.
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Çelik G, Karakaya G, Öztürk A, Gelincik A, Abadoğlu Ö, Sin A, Damadoğlu E, Yılmaz İ, Demirtürk M, Dursun B, Özdemir S, Çelikel S, Değirmenci P, Bozkurt B, Göksel Ö, Erkekol F, Aydın Ö, Kavut A, Kırmaz C, Kalpaklıoğlu F, Büyüköztürk S, Kalyoncu F. Drug allergy in tertiary care in Turkey: results of a national survey. The ADAPT study: adult drug allergy perception in Turkey. Allergol Immunopathol (Madr) 2014; 42:573-9. [PMID: 24269184 DOI: 10.1016/j.aller.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 07/01/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND No data are available on the incidence of drug hypersensitivity (DH) reactions in outpatient settings of tertiary allergy/immunology clinics. Our aims were to document the frequency of outpatient hospital admissions due to DH reactions to allergy/immunology clinics in adults and the management of these reactions in real life. We also investigated whether drug allergy affected social and medical behaviours of the patients. METHODS This multi-centre study was performed for one year with the participation of 11 out of 16 tertiary allergy/clinical immunology clinics in Turkey. The study group consisted of the patients with DH reactions. Results of a questionnaire including drug reactions and management were recorded. RESULTS Among 54,863 patients, 1000 patients with DH were enrolled with a median of 2.1% of all admissions. In real life conditions, the majority of approaches were performed for finding safe alternatives (65.5%; 1102 out of 1683) with 11.7% positivity. Diagnostic procedures were positive in 27% (154/581) of the patients. The majority of the patients had higher VAS scores for anxiety. A total of 250 subjects (25%) reported that they delayed some medical procedures because of DH. CONCLUSION Our results documented the frequency of admissions due to DH reactions to allergy/clinical immunology clinics for the first time. Although physicians mostly preferred to perform drug tests in order to find safe alternatives, considering the fact that DH was confirmed in 27% of the patients, use of diagnostic tests should be encouraged, if no contraindication exists in order to avoid mislabelling patients as DH.
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Bavbek S, Çelik GE, Aydın Ö, Öner Erkekol F, Kurşun N, Mungan D, Mısırlıgil Z. Prevalence of hypersensitivity reactions against drugs among adult population in Turkey: a self-reported survey. J Public Health (Oxf) 2012. [DOI: 10.1007/s10389-012-0496-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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