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Llamas-Molina J, Navarro-Triviño F, Ruiz-Villaverde R. Tiazidas: lo que el dermatólogo debería saber. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:498-504. [DOI: 10.1016/j.ad.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022] Open
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[Translated article] What Dermatologists Should Know About Thiazides. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely hyposalivation, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, reactive keratosis, dysesthesia, osteonecrosis, infection, angioedema, and malignancy.
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Affiliation(s)
- Anna Yuan
- Division of Oral Medicine, Tufts University School of Dental Medicine, 1 Kneeland Street, Boston, MA 02111, USA.
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
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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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Okumu M, Ochola F, Bodo C, Apuoyo K, Odhiambo N, Ng'ong'a A. Enalapril-Induced Angioedema: Two Case Reports in a Rural Health Facility in Kenya. Cureus 2018; 10:e2572. [PMID: 29974027 PMCID: PMC6029729 DOI: 10.7759/cureus.2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tolerability, a good safety profile, affordability, and a preponderance to afford cardio-renal protection in patients with diabetes make enalapril one of the most commonly prescribed angiotensin-converting enzyme (ACE) inhibitors. However, there is low awareness of enalapril/ACE inhibitor-induced angioedema among medical personnel. This is because the diagnosis presents an ongoing challenge, particularly when the presentation is delayed following long-term therapy with ACE inhibitors. Here, we present two cases: a 58-year-old female and a 55-year-old male who presented to the outpatient department of Nyakach County Hospital, Pap Onditi village, Kenya, with progressive swelling of the face and upper and lower lips and stridor of 11 and 10 hours, respectively, after their usual dose of enalapril. Case 1 resolved following the administration of stat doses of intravenous (IV) hydrocortisone 200 mg and IV chlorpheniramine 20 mg as well as thrice daily peroral doses of chlorpheniramine 8 mg, and tapered peroral doses of prednisolone: 40 mg thrice daily for five days, 20 mg thrice daily for five days, 10 mg thrice daily for five days, and 5 mg thrice daily for five days. Case 2 resolved following the administration of a stat dose of IV dexamethasone, a twice daily peroral dose of cetrizine 10 mg, and tapered peroral doses of prednisolone: 20 mg thrice daily for five days, 10 mg thrice daily for five days, and 5 mg thrice daily for five days.
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Affiliation(s)
- Mitchel Okumu
- Department of Pharmacy, Jaramogi Oginga Odinga Teaching and Referral Hospital
| | - Francis Ochola
- Department of Pharmacology and Toxicology, Moi University School of Medicine
| | - Calvin Bodo
- Department of Clinical Medicine, Nyakach County Hospital
| | - Kevin Apuoyo
- Department of Clinical Medicine, Nyakach County Hospital
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Probable hydrochlorothiazide-induced myopericarditis: first case reported. Case Rep Med 2015; 2015:319086. [PMID: 25861276 PMCID: PMC4377349 DOI: 10.1155/2015/319086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/07/2015] [Indexed: 11/25/2022] Open
Abstract
Hydrochlorothiazide has never been reported as a reason for myopericarditis. An African American female, with past history of hypertension, coronary artery disease, and sulfa allergy, presented with indolent onset and retrosternal chest pain which was positional, pleuritic, and unresponsive to sublingual nitroglycerin. Her medications included hydrochlorothiazide (HCTZ) which was started three months ago for uncontrolled hypertension. Significant laboratory parameters included erythrocyte sedimentation rate (ESR) of 47 mm/hr and peak troponin of 0.26 ng/mL. Transthoracic echocardiogram (TTE) revealed preserved ejection fraction with no segmental wall motion abnormalities; however, it showed moderate pericardial effusion without tamponade physiology. We hypothesize that this myopericarditis could be due to HCTZ allergic reaction after all other common etiologies have been ruled out. There is a scarcity of the literature regarding HCTZ as an etiology for pericardial disease, with only one case reported as presumed hydrochlorothiazide-induced pericardial effusion. Management involves discontinuation of HCTZ and starting anti-inflammatory therapy.
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Adverse drug events in the oral cavity. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 119:35-47. [PMID: 25442252 DOI: 10.1016/j.oooo.2014.09.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/18/2014] [Accepted: 09/10/2014] [Indexed: 01/19/2023]
Abstract
Adverse reactions to medications are common and may have a variety of clinical presentations in the oral cavity. Targeted therapies and the new biologic agents have revolutionized the treatment of cancers, autoimmune diseases, and inflammatory and rheumatologic diseases but have also been associated with adverse events in the oral cavity. Some examples include osteonecrosis, seen with not only bisphosphonates but also antiangiogenic agents, and the distinctive ulcers caused by mammalian target of rapamycin inhibitors. As newer therapeutic agents are approved, it is likely that more adverse drug events will be encountered. This review describes the most common clinical presentations of oral mucosal reactions to medications, namely, xerostomia, lichenoid reactions, ulcers, bullous disorders, pigmentation, fibrovascular hyperplasia, white lesions, dysesthesia, osteonecrosis, infection, angioedema, and malignancy. Oral health care providers should be familiar with such events, as they will encounter them in their practice.
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Grandeau E, Turbelin A, Schmidt J, Gras-Champel V, Chourbagi C. [Bradykinin mediated angioedema with ACE inhibitor in combination with immunosupressive agents]. Therapie 2014; 69:189-92. [PMID: 24926642 DOI: 10.2515/therapie/2013071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 10/17/2013] [Indexed: 11/20/2022]
Abstract
We present a serious case of bradykinin mediated angioedema with upper airway disorders resulting from drug interaction between angiotensin-converting enzyme inhibitors and immunosuppressant agents.
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Was treatment the trigger? Mycosis fungoides. Am J Med 2013; 126:1048-9. [PMID: 24083643 DOI: 10.1016/j.amjmed.2013.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 08/09/2013] [Accepted: 08/09/2013] [Indexed: 11/20/2022]
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Wulf NR, Matuszewski KA. Sulfonamide cross-reactivity: Is there evidence to support broad cross-allergenicity? Am J Health Syst Pharm 2013; 70:1483-94. [DOI: 10.2146/ajhp120291] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Objective: To report a case of simvastatin-induced angioedema in a patient with near nightly episodes of orofacial angioedema. Case Summary: A 75-year-old African American female presented to the emergency department with recurrent face, lip, and tongue swelling. The patient described frequent episodes of orofacial edema, with 4 emergency department visits over the previous 6 months. Her home medications were reviewed and simvastatin was identified as a possible contributing medication. Simvastatin was discontinued with resolution of the symptoms during hospitalization and a significant reduction in episodes. Discussion: Drug-induced angioedema has been documented with several agents, most commonly angiotensin-converting enzyme inhibitors. The association with different drug classes has led to several postulated pathways for the development of angioedema. Notable mechanisms include mediation by bradykinin, inhibition of arachidonic acid metabolism, and complement activation. Each pathway culminates in increasing vascular permeability causing fluid accumulation in subcutaneous tissues. While statin use has been associated with drug-induced angioedema in postmarketing reports, there are no published cases involving simvastatin. Use of the Naranjo probability scale demonstrated a probable relationship between simvastatin use and the patient's recurrent angioedema. Conclusions: While statin use is not commonly associated with angioedema, clinicians must be aware of this possible adverse reaction. Consideration must also be given to potential drug interactions, increasing the risk of this adverse event.
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Affiliation(s)
- Sarah A Nisly
- SARAH A NISLY PharmD BCPS, Assistant Professor, Department of Pharmacy Practice, College of Pharmacy and Health Sciences, Butler University, Indianapolis, IN; Clinical Pharmacy Specialist, Internal Medicine, Indiana University Health, Methodist Hospital, Indianapolis
| | - Areeba Kara
- AREEBA KARA MD, Inpatient Medicine, Indiana University Health, Methodist Hospital
| | - Tamara B Knight
- TAMARA B KNIGHT PharmD BCPS, Clinical Pharmacy Specialist, Internal Medicine, Seton Northwest Hospital, Austin, TX
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Chaskes MJ, Chaskes MB. Presumed hydrochlorothiazide-associated immunologic-hypersensitivity-induced pericardial effusion. SAGE Open Med Case Rep 2013; 1:2050313X13496506. [PMID: 27489626 PMCID: PMC4857272 DOI: 10.1177/2050313x13496506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 50-year-old Caucasian female presented for a second opinion regarding a newly diagnosed pericardial effusion. Seven months previously, hydrochlorothiazide was introduced into her pharmacologic regimen to aid in the management of her hypertension. A routine echocardiogram indicated a large pericardial effusion with signs of early cardiac tamponade. The patient subsequently underwent successful pericardiocentesis with complete drainage of the pericardial effusion. The effusion was empirically attributed to a viral etiology. Repeat echocardiograms showed recurrence of the pericardial effusion. Prior to undergoing a second pericardiocentesis with pericardial biopsy, as her physicians recommended, the patient sought a second opinion. While obtaining the patient’s history, an allergy to sulfa was elicited. The possibility that the pericardial effusion may be secondary to an immunologic-hypersensitivity reaction was considered. It was recommended the patient discontinue the use of hydrochlorothiazide. Nine days following discontinuation of hydrochlorothiazide and without any other intervention, an echocardiogram was reported to show the size of the pericardial effusion had subsided substantially. Nine weeks following discontinuation, almost complete resolution of the pericardial effusion was reported. It is hypothesized that when treated with hydrochlorothiazide, the patient had an immune response leading to the pericardial effusion.
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Affiliation(s)
- Michael J Chaskes
- Department of Medicine, Division of Cardiology, State University of New York at Buffalo, Amherst, NY, USA
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Jahan-Tigh RR, Huen AO, Lee GL, Pozadzides JV, Liu P, Duvic M. Hydrochlorothiazide and cutaneous T cell lymphoma: prospective analysis and case series. Cancer 2012; 119:825-31. [PMID: 22952039 DOI: 10.1002/cncr.27740] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/19/2012] [Accepted: 06/20/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Mycosis fungoides (MF) and leukemic Sézary syndrome (SS) are the most common cutaneous T cell lymphomas (CTCL), but their etiology remains unknown. After patients were observed with hydrochlorothiazide (HCTZ)-associated CTCL, HCTZ was examined as a putative chronic antigen in a cohort of prospectively staged patients. METHODS Demographic and drug exposure data was examined from 1443 confirmed MF and SS patients. Hypertensive CTCL patients were divided into HCTZ users or nonusers for statistical analysis by chi-square and t tests. Causality in a case series was rated by the Naranjo Adverse Drug Reaction Probability Scale. RESULTS A total of 815 of 1443 MF and SS patients (56.5%) were hypertensive; 205 (25.2%) were taking HCTZ at initial staging. Comparing stage of patients who were using or not using HCTZ, the most significant difference was between stage I and stage IV (odds ratio of 0.45; 95% confidence interval of 0.25-0.78, P = .003), demonstrating reduced likelihood of being stage IV in patients who were on HCTZ. Seventy-seven percent of the MF patients on HCTZ were stage I. A total of 125 patients of 196 (63.8%) started HCTZ prior to developing CTCL lesions, and 35 of 121 (28.0%) started within 1 year of first skin rash. Thirty-six of 125 patients (28.8%) experienced complete or partial remissions after discontinuing HCTZ. A monoclonal T cell receptor rearrangement was detected more frequently in the hypertensive stage I patients not taking HCTZ as compared with those who were (55.3% vs 69.1%, P = .032). Three patients were rechallenged and developed MF lesions that resolved or improved with discontinuation. CONCLUSIONS HCTZ is commonly prescribed and may be a putative antigen in a small subset of early MF patients. Careful drug histories and a trial off medication are warranted.
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Affiliation(s)
- Richard R Jahan-Tigh
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Ekmekçi P, Bengisun ZK, Kazbek BK, Akmansu H, Beriat GK, Süer AH. Oropharyngeal angioneurotic edema due to recombinant tissue plasminogen activator following massive pulmonary thromboembolism. Int Immunopharmacol 2011; 11:1384-5. [PMID: 21570492 DOI: 10.1016/j.intimp.2011.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 04/11/2011] [Accepted: 04/28/2011] [Indexed: 10/18/2022]
Abstract
Although hypersensitivity reactions secondary to recombinant tissue plasminogen activator (rtPA) are rarely encountered, they may have important consequences. In this case presentation, oropharyngeal angioneurotic edema due to rtPA following pulmonary thromboembolism is presented. On the 4th hour of initiation of treatment, throat pain, laryngeal stridor and expansive edema in the neck ensued, upon which the patient was intubated and mechanically ventilated. The patient was extubated after her findings showed a remission on the 48th hour of his inotropic, antihistaminic and intravenous corticosteroid therapy.
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Affiliation(s)
- Perihan Ekmekçi
- Ufuk University Faculty of Medicine, Dr. Rıdvan Ege Hospital, Anesthesiology and Reanimation, Turkey.
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Mineo MC, Cheng EY. Severe allergic reaction to hydrochlorothiazide mimicking septic shock. Pharmacotherapy 2009; 29:357-61. [PMID: 19249954 DOI: 10.1592/phco.29.3.357] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hydrochlorothiazide (HCTZ) is a sulfonamide-containing drug with commonly reported adverse effects that include electrolyte abnormalities, orthostatic hypotension, hyperglycemia, and photosensitivity. A few reports have described rare but serious drug complications such as interstitial pneumonitis, angioedema, and aplastic anemia. We describe a patient who experienced a serious HCTZ-induced adverse event that, to our knowledge, has not yet been reported in the literature. A 78-year-old woman came to the emergency department with dyspnea and severe fatigue; her signs and symptoms were suggestive of septic shock from pneumonia. She was treated accordingly, her condition improved, and she was discharged home. During the next 2 months, the patient returned to the emergency department 2 more times and was hospitalized each time with the same diagnosis. During her third admission, it was discovered that the patient's primary care physician had restarted her HCTZ for hypertension after it had been discontinued during each of the first two hospitalizations. The patient's symptoms began within hours of the first and second hospitalizations and almost immediately after taking a dose of HCTZ on the day of the third hospitalization. Her medical history revealed documented allergic reactions to sulfonamide drugs and penicillin; thus a hypersensitivity reaction to HCTZ was suspected. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient's hypersensitivity reactions and HCTZ therapy. Because of a lack of evidence showing cross-reactivity among the different classes of sulfonamides, the mechanism of the allergic reaction to HCTZ was unlikely to be cross-sensitivity between sulfonamide antibiotics and sulfonamide nonantibiotic drugs. Although the mechanism is not clear, evidence shows that the allergy to the HCTZ (sulfonamide nonantibiotic) may be due to a predisposition to drug allergies rather than sulfonamide cross-sensitivity. Clinicians should be aware of the potential for these types of allergic reactions.
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Affiliation(s)
- Monica C Mineo
- Kaiser Permanente Medical Center, San Jose, California 95119, USA
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