1
|
Doña I, Torres MJ, Celik G, Phillips E, Tanno LK, Castells M. Changing patterns in the epidemiology of drug allergy. Allergy 2024; 79:613-628. [PMID: 38084822 DOI: 10.1111/all.15970] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/23/2023] [Accepted: 11/26/2023] [Indexed: 03/01/2024]
Abstract
Drug allergy (DA) remains a complex and unaddressed problem worldwide that often deprives patients of optimal medication choices and places them at risk for life-threatening reactions. Underdiagnosis and overdiagnosis are common and due to the lack of standardized definitions and biomarkers. The true burden of DA is unknown, and recent efforts in data gathering through electronic medical records are starting to provide emerging patterns around the world. Ten percent of the general population engaged in health care claim to have a DA, and the most common label is penicillin allergy. Up to 20% of emergency room visits for anaphylaxis are due to DA and 15%-20% of hospitalized patients report DA. It is estimated that DA will increase based on the availability and use of new and targeted antibiotics, vaccines, chemotherapies, biologicals, and small molecules, which are aimed at improving patient's options and quality of life. Global and regional variations in the prevalence of diseases such as human immunodeficiency virus and mycobacterial diseases, and the drugs used to treat these infections have an impact on DA. The aim of this review is to provide an update on the global impact of DA by presenting emerging data on drug epidemiology in adult and pediatric populations.
Collapse
Affiliation(s)
- Immaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Malaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Maria Jose Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Malaga, Spain
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
- Departamento de Medicina, Universidad de Málaga, Malaga, Spain
| | - Gulfem Celik
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Elizabeth Phillips
- Department of Medicine, Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Luciana Kase Tanno
- Division of Allergy, Department of Pulmonology, Allergy and Thoracic Oncology, University Hospital of Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA11 University of Montpellier-INSERM, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Mariana Castells
- Division of Allergy and Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Bereznyakov I, Imanova N, Doroshenko O, Lebedynska M. CROSS-REACTIVITY TO ANTIBIOTICS: PROPOSITIONS FOR SELECTING ALTERNATIVES. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1752-1756. [PMID: 35962693 DOI: 10.36740/wlek202207126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim: To analyze CR among antibacterials of different classes and to overcome some widespread misconceptions regarding CR between different classes of antibiotics. PATIENTS AND METHODS Materials and methods: The narrative review represents an assessment of the most pertinent literary sources published in English language, which dealt with the issues of cross-reactivity between individual antibiotics and different classes of these ones. CONCLUSION Conclusions: With a high probability of type I AR in a patient in the past, it is better to plan the treatment of patients together with an allergist / immunologist. If this probability is estimated to be low, the choice of a particular antibiotic may be based to some extent on CR data.
Collapse
Affiliation(s)
- Igor Bereznyakov
- KHARKIV MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KHARKIV, UKRAINE
| | - Nataliia Imanova
- KHARKIV MEDICAL ACADEMY OF POSTGRADUATE EDUCATION, KHARKIV, UKRAINE
| | | | | |
Collapse
|
3
|
Drug-Related Hypersensitivity Reactions Leading to Emergency Department: Original Data and Systematic Review. J Clin Med 2022; 11:jcm11102811. [PMID: 35628936 PMCID: PMC9143688 DOI: 10.3390/jcm11102811] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 12/17/2022] Open
Abstract
The aim of the present study is to describe pharmacological characteristics of drug-related allergies and anaphylaxis leading to the emergency department (ED). An 8-year post hoc analysis on the MEREAFaPS Study database was performed (2012−2019). Subjects who experienced drug-related hypersensitivity leading to an ED visit were selected. Logistic regression analyses were used to estimate the reporting odds ratios (RORs) of drug-related allergies and anaphylaxis adjusting for sex, age classes, and ethnicity. In addition, a systematic review of observational studies evaluating drug-related hypersensitivity reactions leading to ED visits in outpatients was performed. Out of 94,073 ED visits, 14.4% cases were drug-related allergies and 0.6% were anaphylaxis. Females accounted for 56%. Multivariate logistic regression showed a higher risk of drug-related allergy among males and all age classes < 65 years, while a higher risk of anaphylaxis was observed for females (ROR 1.20 [1.01−1.42]) and adults (ROR 2.63 [2.21−3.14]). The systematic review included 37 studies. ED visits related to allergy and anaphylaxis ranged from 0.004% to 88%, and drug-related allergies and anaphylaxis ranged from 0.007% to 88%. Both in our analysis and in primary studies, antibacterials, analgesics, and radiocontrast agents were identified as the most common triggers of hypersensitivity.
Collapse
|
4
|
Road Less Traveled: Drug Hypersensitivity to Fluoroquinolones, Vancomycin, Tetracyclines, and Macrolides. Clin Rev Allergy Immunol 2022; 62:505-518. [DOI: 10.1007/s12016-021-08919-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
|
5
|
Gelincik A, Demir S. Hypersensitivity Reactions to Non-Beta Lactam Antibiotics. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00293-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
6
|
Elst J, Maurer M, Sabato V, Faber MA, Bridts CH, Mertens C, Van Houdt M, Van Gasse AL, van der Poorten MLM, De Puysseleyr LP, Hagendorens MM, Van Tendeloo VF, Lion E, Campillo-Davo D, Ebo DG. Novel Insights on MRGPRX2-Mediated Hypersensitivity to Neuromuscular Blocking Agents And Fluoroquinolones. Front Immunol 2021; 12:668962. [PMID: 34385999 PMCID: PMC8353374 DOI: 10.3389/fimmu.2021.668962] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
Neuromuscular blocking agents (NMBAs) like atracurium and rocuronium as well as fluoroquinolones (FQs) cause mast cell-mediated anaphylaxis by activating Mas-related G protein-coupled receptor X2 (MRGPRX2), but many questions remain unanswered. Here, we address three of them, namely whether primary human mast cells show similar activation by these drugs as murine mast cells and mast cell lines, how sugammadex protects from atracurium-induced MRGPRX2-mediated mast cell activation, and why some but not all patients treated with rocuronium develop anaphylaxis. We used peripheral blood-derived cultured mast cells from healthy donors and patients, assessed mast cell activation and degranulation by quantifying intracellular calcium and CD63 expression, respectively, and made use of MRGPRX2-silencing, via electroporation with Dicer-substrate small interfering RNAs, and single cell flow cytometric analyses. Atracurium, ciprofloxacin, and levofloxacin activated and degranulated primary human mast cells, but only MRGPRX2-positive and not MRGPRX2-negative or -silenced mast cells. Sugammadex attenuated the atracurium-induced and MRGPRX2-mediated activation and degranulation of human mast cells by reducing free atracurium levels. The mast cells of patients with IgE-independent anaphylaxis to rocuronium were similar, in their MRGPRX2 expression and function, to those of patients with IgE-mediated anaphylaxis. These findings further improve our understanding of the role and relevance of MRGPRX2-driven mast cell activation in anaphylactic reactions to NMBAs and FQs and may help to improve their prediction, prevention, and treatment.
Collapse
Affiliation(s)
- Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Marcus Maurer
- Dermatological Allergology, Allergie-Centrum-Charité, Department of Dermatology and Allergy, Charité - Universitätsmedizin, Berlin, Germany
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology, AZ Jan Palfijn Hospital Gent, Ghent, Belgium
| | - Margaretha A Faber
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Chris H Bridts
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Marie-Line M van der Poorten
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Leander P De Puysseleyr
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Viggo F Van Tendeloo
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Eva Lion
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Diana Campillo-Davo
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology, AZ Jan Palfijn Hospital Gent, Ghent, Belgium
| |
Collapse
|
7
|
File TM, Alexander E, Goldberg L, Das AF, Sandrock C, Paukner S, Moran GJ. Lefamulin efficacy and safety in a pooled phase 3 clinical trial population with community-acquired bacterial pneumonia and common clinical comorbidities. BMC Pulm Med 2021; 21:154. [PMID: 33964925 PMCID: PMC8105923 DOI: 10.1186/s12890-021-01472-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/17/2021] [Indexed: 01/22/2023] Open
Abstract
Background Lefamulin, a first-in-class pleuromutilin antibiotic approved for intravenous and oral use in adults with community-acquired bacterial pneumonia (CABP), was noninferior to moxifloxacin in the Lefamulin Evaluation Against Pneumonia (LEAP) 1 intravenous-to-oral switch study and the LEAP 2 oral-only study. Using pooled LEAP 1/2 data, we examined lefamulin efficacy/safety overall and within subgroups of patients presenting with comorbidities typical in CABP management. Methods In LEAP 1, adults with CABP were randomized to receive intravenous lefamulin (150 mg every 12 h) for 5‒7 days or moxifloxacin (400 mg every 24 h) for 7 days, with optional intravenous-to-oral switch if predefined improvement criteria were met. In LEAP 2, adults with CABP were randomized to receive oral lefamulin (600 mg every 12 h) for 5 days or moxifloxacin (400 mg every 24 h) for 7 days. Both studies assessed early clinical response (ECR) at 96 ± 24 h after first study drug dose and investigator assessment of clinical response (IACR) at test-of-cure (5‒10 days after last dose). Pooled analyses of the overall population used a 10% noninferiority margin. Results Lefamulin (n = 646) was noninferior to moxifloxacin (n = 643) for ECR (89.3% vs 90.5%, respectively; difference − 1.1%; 95% CI − 4.4 to 2.2); IACR success rates at test-of-cure were similarly high (≥ 85.0%). High efficacy with both lefamulin and moxifloxacin was also demonstrated across all well-represented patient subgroups, including those with advanced age, diabetes mellitus, a history of cardiovascular diseases (e.g., hypertension, congestive heart failure, or arrhythmia) or chronic lung diseases (e.g., asthma or chronic obstructive pulmonary disease), elevated liver enzymes, or mild-to-moderate renal dysfunction. No new safety signals were identified. Conclusions Lefamulin may provide a valuable intravenous/oral monotherapy alternative to fluoroquinolones or macrolides for empiric treatment of patients with CABP, including cases of patients at risk for poor outcomes due to age or various comorbidities. Trial registration ClinicalTrials.gov LEAP 1 (NCT02559310; Registration Date: 24/09/2015) and LEAP 2 (NCT02813694; Registration Date: 27/06/2016). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01472-z.
Collapse
Affiliation(s)
| | - Elizabeth Alexander
- Nabriva Therapeutics US, Inc., Fort Washington, PA, USA. .,Vir Biotechnology, Inc., 499 Illinois Street, Suite 500, San Francisco, CA, 94158, USA.
| | - Lisa Goldberg
- Nabriva Therapeutics US, Inc., Fort Washington, PA, USA
| | | | | | | | | |
Collapse
|
8
|
Doña I, Pérez-Sánchez N, Salas M, Barrionuevo E, Ruiz-San Francisco A, Hernández Fernández de Rojas D, Martí-Garrido J, Andreu-Ros I, López-Salgueiro R, Moreno E, Torres MJ. Clinical Characterization and Diagnostic Approaches for Patients Reporting Hypersensitivity Reactions to Quinolones. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:2707-2714.e2. [PMID: 32376487 DOI: 10.1016/j.jaip.2020.04.051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. OBJECTIVE To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. METHODS Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BATs), and drug provocation tests (DPTs) if ST and BAT results were negative. RESULTS We included 128 subjects confirmed as having HSRs to quinolones and 42 found to be tolerant. Anaphylaxis was the most frequent entity in immediate HSRs and was most commonly induced by moxifloxacin. Patients were evaluated a median of 150 days (interquartile range, 60-365 days) after the reaction. Of patients who underwent ST and BAT, 40.7% and 70%, respectively, were positive. DPT with a quinolone was performed in 48 cases, giving results depending on the culprit drug: when moxifloxacin was involved, 62.5% of patients gave a positive DPT result to ciprofloxacin, whereas none reacted to levofloxacin. The risk of HSR was 96 times higher in subjects who reported moxifloxacin-induced anaphylaxis and 18 times higher in those reporting immediate reactions compared with clinical entities induced by quinolones other than moxifloxacin and nonimmediate reactions. CONCLUSIONS The diagnosis of HSR to quinolones is complex. The use of clinical history is essential as a first step. BAT shows higher sensitivity than STs. DPTs can be useful for finding safe alternative quinolones.
Collapse
Affiliation(s)
- Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain.
| | - Natalia Pérez-Sánchez
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
| | - María Salas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain
| | - Esther Barrionuevo
- Asthma and Immunoallergic Diseases Research Group, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain; Allergy Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Dolores Hernández Fernández de Rojas
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain; Department of Allergy, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jaume Martí-Garrido
- Department of Allergy, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Inmaculada Andreu-Ros
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain
| | - Ramón López-Salgueiro
- Unidad Mixta de Investigación IIS La Fe-UniversitatPolitècnica deValència, Hospital Universitari i Politècnic La Fe, Avenida de Fernando Abril Martorell 106, Valencia, Spain
| | - Esther Moreno
- Allergy Service, University Hospital of Salamanca, Salamanca, Spain; Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - María José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Civil, Málaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Hospital Civil, Málaga, Spain; Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Parque Tecnológico de Andalucía, Málaga, Spain; Departamento de Medicina, Universidad de Málaga, Facultad de Medicina, Málaga, Spain
| |
Collapse
|
9
|
van der Poorten MLM, Van Gasse AL, Hagendorens MM, Faber MA, De Puysseleyr L, Elst J, Mertens CM, Sabato V, Ebo DG. Serum specific IgE antibodies in immediate drug hypersensitivity. Clin Chim Acta 2020; 504:119-124. [DOI: 10.1016/j.cca.2020.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/20/2022]
|
10
|
McGee EU, Samuel E, Boronea B, Dillard N, Milby MN, Lewis SJ. Quinolone Allergy. PHARMACY 2019; 7:pharmacy7030097. [PMID: 31330937 PMCID: PMC6789783 DOI: 10.3390/pharmacy7030097] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/10/2023] Open
Abstract
Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.
Collapse
Affiliation(s)
- Edoabasi U McGee
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Essie Samuel
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Bernadett Boronea
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Nakoasha Dillard
- School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA 30024, USA
| | - Madison N Milby
- College of Pharmacy, University of Findlay, Findlay, OH 45840, USA
| | - Susan J Lewis
- Department of Pharmacy Practice, College of Pharmacy, University of Findlay, Findlay, OH 45840, USA.
- Mercy Health-St. Anne Hospital, Toledo, OH 43623, USA.
| |
Collapse
|
11
|
Gong CL, Zangwill KM, Hay JW, Meeker D, Doctor JN. Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. J Gen Intern Med 2019; 34:846-854. [PMID: 29740788 PMCID: PMC6544688 DOI: 10.1007/s11606-018-4467-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Behavioral economics interventions have been shown to effectively reduce the rates of inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). OBJECTIVE To determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for ARIs. DESIGN Thirty-year Markov model from the US societal perspective with inputs derived from the literature and CDC surveillance data. SUBJECTS Forty-five-year-old adults with signs and symptoms of ARI presenting to a healthcare provider. INTERVENTIONS (1) Provider education on guidelines for the appropriate treatment of ARIs; (2) Suggested Alternatives, which utilizes computerized clinical decision support to suggest non-antibiotic treatment choices in lieu of antibiotics; (3) Accountable Justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and (4) Peer Comparison, which sends a periodic email to prescribers about his/her rate of inappropriate antibiotic prescribing relative to clinician colleagues. MAIN MEASURES Discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. KEY RESULTS Each intervention has lower costs but higher QALYs compared to provider education. Total costs for each intervention were $178.21, $173.22, $172.82, and $172.52, and total QALYs were 14.68, 14.73, 14.74, and 14.74 for the control, Suggested Alternatives, Accountable Justification, and Peer Comparison groups, respectively. Results were most sensitive to the quality-of-life of the uninfected state, and the likelihood and costs for antibiotic-associated adverse events. CONCLUSIONS Behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
Collapse
Affiliation(s)
- Cynthia L Gong
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.
| | - Kenneth M Zangwill
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Joel W Hay
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Daniella Meeker
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jason N Doctor
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| |
Collapse
|
12
|
Lo Giudice I, Mocciaro E, Giardina C, Barbieri MA, Cicala G, Gioffrè-Florio M, Carpinteri G, Di Grande A, Spina E, Arcoraci V, Cutroneo PM. Characterization and preventability of adverse drug events as cause of emergency department visits: a prospective 1-year observational study. BMC Pharmacol Toxicol 2019; 20:21. [PMID: 31029178 PMCID: PMC6486973 DOI: 10.1186/s40360-019-0297-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 04/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adverse drug events (ADEs) are a significant cause of emergency department (ED) visits, with a major impact on healthcare resource utilization. A multicentre observational study, aimed to describe frequency, seriousness and preventability of ADEs reported in four EDs, was performed in Sicily (Italy) over a 1-year period. METHODS Two trained monitors for each ED supported clinicians in identifying ADEs of patients admitted to EDs between June 1st, 2013 and May 31st, 2014 through a systematic interview of patients or their caregivers and with an additional record review. A research team analyzed each case of suspected ADE, to make a causality assessment applying the Naranjo algorithm and a preventability assessment using Schumock and Thornton criteria. Absolute and percentage frequencies with 95% confidence interval (CI) and medians with interquartile ranges (IQR) were estimated. Logistic regression models were used to evaluate independent predictors of serious and certainly preventable ADEs. RESULTS Out of 16,963 ED visits, 575 (3.4%) were associated to ADEs, of which 15.1% resulted in hospitalization. ADEs were classified as probable in 45.9%, possible in 51.7% and definite in 2.4% of the cases. Moreover, ADEs were considered certainly preventable in 12.3%, probably preventable in 58.4%, and not preventable in 29.2% of the cases. Polytherapy influenced the risk to experience a serious, as well as a certainly preventable ADE. Whilst, older age resulted an independent predictor only of serious events. The most common implicated drug classes were antibiotics (34.4%) and anti-inflammatory drugs (22.6%). ADEs due to psycholeptics and antiepileptics resulted preventable in 62.7 and 54.5% of the cases, respectively. Allergic reactions (64%) were the most frequent cause of ADE-related ED visits, followed by neurological effects (10.2%) that resulted preventable in 1.9 and 37.3% of the cases, respectively. CONCLUSION ADEs are a frequent cause of ED visits. The commonly used antibiotics and anti-inflammatory drugs should be carefully managed, as they are widely involved in mild to severe ADEs. Polytherapy is associated with the occurrence of serious, as well as certainly preventable ADEs, while older age only with serious events. A greater sensitivity to drug monitoring programs among health professionals is needed.
Collapse
Affiliation(s)
- Ivan Lo Giudice
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Eleonora Mocciaro
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Claudia Giardina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Maria Antonietta Barbieri
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
| | - Maria Gioffrè-Florio
- Department of Emergency Medicine, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
| | - Giuseppe Carpinteri
- Department of Emergency Medicine, University Hospital V. Emanuele, Via S. Sofia, 95123, Catania, Italy
| | - Aulo Di Grande
- Department of Emergency Medicine, General Hospital S. Elia, Via Luigi Russo, 93100, Caltanissetta, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
| | - Vincenzo Arcoraci
- Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria, 98125, Messina, Italy.
| | - Paola Maria Cutroneo
- Sicilian Regional Pharmacovigilance Center, Clinical Pharmacology Unit, University Hospital G. Martino, Via Consolare Valeria, 98125, Messina, Italy
| |
Collapse
|
13
|
Porebski G, Kwiecien K, Pawica M, Kwitniewski M. Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2) in Drug Hypersensitivity Reactions. Front Immunol 2018; 9:3027. [PMID: 30619367 PMCID: PMC6306423 DOI: 10.3389/fimmu.2018.03027] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/06/2018] [Indexed: 12/15/2022] Open
Abstract
The human ortholog MRGPRX2 and the mice ortholog, Mrgprb2 are activated by basic secretagogues and neurokinins. A number of commonly used small-molecule drugs (e.g., neuromuscular blocking agents, fluoroquinolones, vancomycin) have been recently shown to activate these receptors under in vitro experimental conditions, what results in mast cell degranulation. The above drugs are also known to cause IgE-mediated anaphylactic reactions in allergic patients. The new findings on mechanisms of drug-induced mast cell degranulation may modify the current management of drug hypersensitivity reactions. Clinical interpretation of mild drug-provoked hypersensitivity reactions, interpretation of skin test with a drug of interest or further recommendations for patients suspected of drug allergy are likely to be reconsidered. In the paper we discussed future directions in research on identification and differentiation of MRGPRX2-mediated and IgE-dependent mast cell degranulation in patients presenting clinical features of drug-induced hypersensitivity reactions.
Collapse
Affiliation(s)
- Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Kamila Kwiecien
- Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| | - Magdalena Pawica
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz Kwitniewski
- Department of Immunology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
| |
Collapse
|
14
|
Geller AI, Lovegrove MC, Shehab N, Hicks LA, Sapiano MRP, Budnitz DS. National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults-United States, 2011-2015. J Gen Intern Med 2018; 33:1060-1068. [PMID: 29679226 PMCID: PMC6025673 DOI: 10.1007/s11606-018-4430-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 02/07/2018] [Accepted: 03/20/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Detailed, nationally representative data describing high-risk populations and circumstances involved in antibiotic adverse events (AEs) can inform approaches to prevention. OBJECTIVE Describe US burden, rates, and characteristics of emergency department (ED) visits by adults for antibiotic AEs. DESIGN Nationally representative, public health surveillance of adverse drug events (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance [NEISS-CADES]) and a nationally projected database of dispensed prescriptions (QuintilesIMS), 2011-2015. PATIENTS Antibiotic-treated adults (≥ 20 years) seeking ED care. MAIN MEASURES Estimated annual numbers and rates of ED visits for antibiotic AEs among outpatients treated with systemically administered antibiotics. KEY RESULTS Based on 10,225 cases, US adults aged ≥ 20 years made an estimated 145,490 (95% confidence interval, 115,279-175,701) ED visits for antibiotic AEs each year in 2011-2015. Antibiotics were implicated in 13.7% (12.3-15.2%) of all estimated adult ED visits for adverse drug events. Most (56.6%; 54.8-58.4%) antibiotic AE visits involved adults aged < 50 years, and 71.8% (70.4-73.1%) involved females. Accounting for prescriptions dispensed from retail and long-term care pharmacies, adults aged 20-34 years had twice the estimated rate of ED visits for oral antibiotic AEs compared with those aged ≥ 65 years (9.7 [7.6-11.8] versus 4.6 [3.6-5.7] visits per 10,000 dispensed prescriptions, respectively). Allergic reactions accounted for three quarters (74.3%; 70.0-78.6%) of estimated ED visits for antibiotic AEs. The three most frequently implicated antibiotic classes in ED visits for antibiotic AEs were oral sulfonamides (23.2%; 20.6-25.8%), penicillins (20.8%; 19.3-22.4%), and quinolones (15.7%; 14.2-17.1%). Per-prescription rates declined with increasing age group. CONCLUSIONS Antibiotics are a common cause of ED visits by adults for adverse drug events and represent an important safety issue. Quantifying risks of AEs from specific antibiotics for specific patient populations, such as younger adults, provides additional information to help clinicians assess risks versus benefits when making the decision to prescribe or not prescribe an antibiotic. AE rates may also facilitate communication with patients about antibiotic risks.
Collapse
Affiliation(s)
- Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA.
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA
| | - Nadine Shehab
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA
| | - Lauri A Hicks
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA
| | - Mathew R P Sapiano
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, NE, Mailstop D-26, Atlanta, GA, 30333, USA
| |
Collapse
|
15
|
Van Gasse AL, Sabato V, Uyttebroek AP, Elst J, Faber MA, Hagendorens MM, Mertens C, Bridts CH, De Clerck LS, Ebo DG. Immediate moxifloxacin hypersensitivity: Is there more than currently meets the eye? Allergy 2017; 72:2039-2043. [PMID: 28658502 DOI: 10.1111/all.13236] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 01/04/2023]
Abstract
Immediate drug hypersensitivity reactions (IDHR) to moxifloxacin constitute a pathomechanistic conundrum and a diagnostic challenge. Our objective was to study whether simultaneous phenotyping and quantification of histamine release might add to our knowledge about the basophil activation properties of moxifloxacin and constitute a reliable diagnostic aid. Fifteen patients with an IDHR to moxifloxacin and nine moxifloxacin challenged controls were selected. All had a basophil activation test (BAT) with moxifloxacin. Flow cytometric analysis of basophil responses implied labeling for CD63, CD203c, and intracellular histamine. Unlike tolerant challenged controls, basophilic upregulation of CD203c in response to moxifloxacin was observed in seven of 15 patients. Only two of these seven patients demonstrated appearance of CD63 and release of histamine. In the remainder eight patients, no basophil responses were demonstrable. In conclusion, immediate hypersensitivity to moxifloxacin might involve mechanisms difficult to capture by traditional CD63-/CD203c-based BAT. Deciphering the complexity of quinolone IDHR seems mandatory.
Collapse
Affiliation(s)
- A. L. Van Gasse
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
- Faculty of Medicine and Health Science; Department of Pediatrics; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - V. Sabato
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - A. P. Uyttebroek
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - J. Elst
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - M. A. Faber
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - M. M. Hagendorens
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
- Faculty of Medicine and Health Science; Department of Pediatrics; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - C. Mertens
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - C. H. Bridts
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - L. S. De Clerck
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| | - D. G. Ebo
- Faculty of Medicine and Health Science; Department of Immunology, Allergology, Rheumatology; University of Antwerp; Antwerp University Hospital; Antwerpen Belgium
| |
Collapse
|
16
|
Van Gasse AL, Sabato V, Faber M, Hagendorens MM, Ebo DG. Update on Quinolone Allergy: A Complementary Note. Curr Allergy Asthma Rep 2017; 17:74. [PMID: 28975524 DOI: 10.1007/s11882-017-0742-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Athina L Van Gasse
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95, Universiteitsplein 1, 2610, Antwerpen, Belgium.,Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, 2610, Antwerpen, Belgium
| | - Vito Sabato
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95, Universiteitsplein 1, 2610, Antwerpen, Belgium
| | - Margaretha Faber
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95, Universiteitsplein 1, 2610, Antwerpen, Belgium
| | - Margo M Hagendorens
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95, Universiteitsplein 1, 2610, Antwerpen, Belgium.,Faculty of Medicine and Health Science, Department of Pediatrics, University of Antwerp, Antwerp University Hospital, 2610, Antwerpen, Belgium
| | - Didier G Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95, Universiteitsplein 1, 2610, Antwerpen, Belgium.
| |
Collapse
|
17
|
Abstract
Drug allergy affects a large percentage of the general population. A listed drug allergy can also have broad implications for many aspects of patient care. Here, we will review recent advances in the arena of drug allergies with a focus on antibiotics, monoclonals, NSAIDs, and chemotherapeutics.
Collapse
|
18
|
Rawal G, Yadav S, Kumar R, Wani UR. Ofloxacin Induced Angioedema: A Rare Adverse Drug Reaction. J Clin Diagn Res 2016; 10:FD03-FD04. [PMID: 28050397 DOI: 10.7860/jcdr/2016/21316.8782] [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] [Received: 05/11/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
Abstract
The Adverse Drug Reaction (ADR) to a commonly prescribed anti-microbial can pose a major public health problem. The authors report a rare case of 24-year-old young lady who presented with angioedema of lips after ingestion of Ofloxacin, prescribed to her for treatment of loose motions. Fluoroquinolones are widely prescribed antibiotics for various disease conditions. The history, clinical examination and normal laboratory parameters led to the diagnosis of ofloxacin induced hypersensitivity reaction and the patient was successfully treated with corticosteroids and antihistamines. The hypersensitivity reactions to fluoroquinolones are rare with an incidence of 0.4% to 2%. The pharmacovigilance program and self-reporting of all the ADR's by the health care workers can help in ensuring the judicious use of the drug, drug safety and thus decrease the associated morbidity and mortality.
Collapse
Affiliation(s)
- Gautam Rawal
- Attending Consultant-Respiratory Intensive Care, Max Super Specialty Hospital , Saket, New Delhi, India
| | - Sankalp Yadav
- General Duty Medical Officer-II, Department of Medicine & TB, Chest Clinic Moti Nagar, North Delhi Municipal Corporation, New Delhi, India
| | - Raj Kumar
- Senior Consultant and Incharge-Respiratory Intensive Care, Max Super Specialty Hospital , Saket, New Delhi, India
| | - Umar Rasool Wani
- Clinical Associate, Critical Care, Max Super Specialty Hospital , Vaishali, Ghaziabad, Uttar Pradesh, India
| |
Collapse
|
19
|
Mangodt EA, Van Gasse AL, Bastiaensen A, Decuyper II, Uyttebroek A, Faber M, Sabato V, Bridts CH, Hagendorens MM, De Clerck LS, Ebo DG. Flow-assisted basophil activation tests in immediate drug hypersensitivity: two decades of Antwerp experience. Acta Clin Belg 2016; 71:19-25. [PMID: 27075810 DOI: 10.1080/17843286.2015.1122871] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The last two decades have witnessed that flow-assisted analysis of in vitro-activated basophils can constitute a valuable adjunct in the in vitro diagnostic approach of immediate drug hypersensitivity reactions (IDHR). This article summarises the current experience with the basophil activation test in the diagnosis of IDHR, with particular focus on allergy to curarising neuromuscular blocking agents, antibiotics (β-lactams and fluoroquinolones), iodinated radiocontrast media and opiates.
Collapse
|
20
|
Mangodt EA, Van Gasse AL, Decuyper I, Uyttebroek A, Faber MA, Sabato V, Bridts CH, Hagendorens MM, Ebo DG. In vitro Diagnosis of Immediate Drug Hypersensitivity: Should We Go with the Flow. Int Arch Allergy Immunol 2015; 168:3-12. [PMID: 26524156 DOI: 10.1159/000440663] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diagnosis of immediate drug hypersensitivity reactions (IDHRs) is based upon history taking, skin prick or intradermal tests and quantification of specific immunoglobulin E (IgE) antibodies. Unfortunately, this is often insufficient to correctly identify patients with IgE-mediated IDHRs and is impossible in the case of non-IgE-mediated IDHRs. Drug provocation tests (DPT) are considered the 'gold standard' diagnostic but are not always possible, for ethical and practical reasons. Therefore, the validation of new cellular tests such as basophil activation testing (BAT) was necessary. This review focuses on the applications of BAT in IDHRs. METHODS A literature search was conducted, using the words basophil, flow cytometry, immediate drug allergy and drugs; this was complemented by the authors' own expertise. RESULTS BAT/HistaFlow® is a useful diagnostic tool in IDHRs, mainly used to diagnose allergy to neuromuscular blocking agents (NMBAs), antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs) and iodinated radiocontrast media. Its sensitivity varies between 50 and 60%, and specificity attains 80%, except for with quinolones and NSAIDs. CONCLUSIONS The diagnostic utility of BAT (and to lesser extent HistaFlow) has been demonstrated and is mostly applied in IDHRs. However, larger-scale collaborative studies are necessary to optimize test protocols and validate the entry of BAT as a diagnostic instrument in drug allergy.
Collapse
Affiliation(s)
- Evelyne A Mangodt
- Department of Immunology-Allergology-Rheumatology, Faculty of Medicine and Health Science, University of Antwerp, Antwerp University Hospital, Antwerp, Belgium
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Sachs B, Fischer-Barth W, Merk HF. Reporting rates for severe hypersensitivity reactions associated with prescription-only drugs in outpatient treatment in Germany. Pharmacoepidemiol Drug Saf 2015; 24:1076-84. [DOI: 10.1002/pds.3857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 06/22/2015] [Accepted: 07/21/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Bernhardt Sachs
- Federal Institute for Drugs and Medical Devices; Bonn Germany
- Department of Dermatology and Allergology; University Hospital, RWTH Aachen; Aachen Germany
| | | | - Hans Friedrich Merk
- Department of Dermatology and Allergology; University Hospital, RWTH Aachen; Aachen Germany
| |
Collapse
|
22
|
Quinolones-induced hypersensitivity reactions. Clin Biochem 2015; 48:716-39. [DOI: 10.1016/j.clinbiochem.2015.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 04/05/2015] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
|
23
|
Moxifloxacin hypersensitivity: Uselessness of skin testing. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:443-5. [DOI: 10.1016/j.jaip.2014.12.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 11/18/2022]
|
24
|
Nadia MSA, Sayed MR, Sara AM. Exploration of the neurotoxicity of ciprofloxcin or gatifloxacin single dose in rat cortex and hippocampus. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/ajpp2014.4231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
25
|
Perrone V, Conti V, Venegoni M, Scotto S, Degli Esposti L, Sangiorgi D, Prestini L, Radice S, Clementi E, Vighi G. Seriousness, preventability, and burden impact of reported adverse drug reactions in Lombardy emergency departments: a retrospective 2-year characterization. CLINICOECONOMICS AND OUTCOMES RESEARCH 2014; 6:505-14. [PMID: 25506231 PMCID: PMC4259870 DOI: 10.2147/ceor.s71301] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective The purpose of this study was to determine the prevalence of adverse drug reactions (ADRs) reported in emergency departments (EDs) and carry out a thorough characterization of these to assess preventability, seriousness that required hospitalization, subsequent 30-day mortality, and economic burden. Methods This was a retrospective cohort study of data from an active pharmacovigilance project at 32 EDs in the Lombardy region collected between January 1, 2010 and December 31, 2011. Demographic, clinical, and pharmacological data on patients admitted to EDs were collected by trained and qualified monitors, and deterministic record linkage was performed to estimate hospitalizations. Pharmacoeconomic analyses were based on Diagnosis-Related Group reimbursement. Results 8,862 ADRs collected with an overall prevalence rate of 3.5 per 1,000 visits. Of all ADRs, 42% were probably/definitely preventable and 46.4% were serious, 15% required hospitalization, and 1.5% resulted in death. The System Organ Classes most frequently associated with ADRs were: skin and subcutaneous tissue, gastrointestinal, respiratory thoracic and mediastinal, and nervous system disorders. The most common Anatomical Therapeutic Chemical classes involved in admissions were J (anti-infectives and immunomodulating agents), B (blood and blood-forming organs), and N (nervous system). Older age, yellow and red triage, higher number of concomitantly taken drugs, and previous attendance in ED for the same ADR were significantly associated with an increased risk of hospitalization. The total cost associated with ADR management was €5,184,270, with a mean cost per patient of €585. Fifty-eight percent of the economic burden was defined as probably/definitely preventable. Conclusion ADRs are a serious health/economic issue in EDs. This assessment provides a thorough estimation of their seriousness, preventability, and burden impact in a large population from a representative European region.
Collapse
Affiliation(s)
- Valentina Perrone
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy
| | - Valentino Conti
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | - Mauro Venegoni
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | - Stefania Scotto
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy
| | | | - Diego Sangiorgi
- CliCon Srl, Health, Economics and Outcomes Research, Ravenna, Italy
| | - Lucia Prestini
- Unit of Clinical Pharmacology and Pharmacovigilance, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, University Hospital Luigi Sacco, Università di Milano, Milan, Italy ; Scientific Institute, IRCCS Eugenio Medea, Lecco, Italy
| | - Giuseppe Vighi
- Regional Centre for Pharmacovigilance, Lombardy, Milan, Italy ; Unit of Clinical Pharmacology and Pharmacovigilance, Niguarda Ca'Granda Hospital, Milan, Italy
| |
Collapse
|
26
|
Uyttebroek AP, Sabato V, Bridts CH, Ebo DG. In vitro diagnosis of immediate IgE-mediated drug hypersensitivity: warnings and (unmet) needs. Immunol Allergy Clin North Am 2014; 34:681-9, x. [PMID: 25017685 DOI: 10.1016/j.iac.2014.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Immediate drug hypersensitivity reactions (DHR) constitute an important health condition, with serious consequences of inadequate diagnosis. In this article, some of the most important issues related to in vitro diagnosis of IgE-mediated allergies are discussed. In vitro diagnostics will benefit from expanded and novel insights and understandings in drug chemical reactivity, protein binding, biotransformation, degradation, identification of (cross-reactive) drug antigenic determinants, and deeper understanding of sensitization routes. Collective efforts should be undertaken to activate fundamental and clinical investigations.
Collapse
Affiliation(s)
- Astrid P Uyttebroek
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Chris H Bridts
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology, Faculty of Medicine and Health Science, Antwerp University Hospital, University of Antwerp, Antwerp 2610, Belgium.
| |
Collapse
|