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Wang CC, Chen IC, Lin GC, Chen YM, Shen CH. Polymorphisms of HLA genes and hypersensitivity to penicillin among patients in a Taiwanese population. Int J Immunogenet 2024. [PMID: 38741273 DOI: 10.1111/iji.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/08/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Penicillin allergy is a potentially life-threatening condition that is common among patients. However, the genetic associations with penicillin allergy are not yet recognized for prevention or diagnosis, particularly in East Asian populations. We conducted a retrospective case-control study using data from the Taiwan Precision Medicine Initiative and analysing DNA samples to identify eight major MHC Class I and Class II loci. We employed imputation methods for accurate HLA typing and enrolled 17,827 individuals who received penicillin. Logistic regression analyses were utilized to explore associations between HLA genotypes, comorbidities and allergy risk, while simultaneously conducting a subgroup analysis to explore the association between HLA genotypes, comorbidities and the severity of allergic reactions. Our study assigned 496 cases to the penicillin allergy group and 4960 controls to a matched group. The risk of penicillin allergy was significantly higher with HLA-DPB1*05:01 (OR = 1.36, p = .004) and HLA-DQB1*05:01 (OR = 1.54, p = .03), with adjusted p-values of .032 and .24, respectively. Urticaria was identified as a separate risk factor (OR = 1.73, p < .001). However, neither the HLA alleles nor the comorbidities had a significant relationship with the risk of severe penicillin-induced allergy. HLA-DPB1*05:01 was found to be significantly associated with penicillin allergy reactions among the Taiwanese population.
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Affiliation(s)
- Chih-Chun Wang
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - I-Chieh Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Guan-Cheng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ching-Hui Shen
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
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2
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Saghir SA, Ansari RA. HLA gene variations and mycotoxin toxicity: Four case reports. Mycotoxin Res 2024; 40:159-173. [PMID: 38198040 DOI: 10.1007/s12550-023-00517-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
Mycotoxins are produced by certain molds that can cause many health effects. We present four human cases of prolonged consistent mycotoxins exposure linked to genetic variations in human leukocyte antigen (HLA) alleles. The HLA-DR/DQ isotype alleles are linked to mycotoxins susceptibility due to the lack of proper immune response; individuals with these alleles are poor eliminators of mycotoxins from their system. Four subjects with variations in their HLA-DR alleles were exposed to mycotoxins from living in mold-infested houses and experienced persistent mold-related symptoms long after moving out from the mold-infested houses and only exposed to the levels of molds found in the ambient air. From one of the subjects, two urine samples were collected ~ 18 months apart after the cessation of exposure. Urinary elimination rate was extremely slow for two of the mycotoxins (ochratoxin A [OTA] and mycophenolic acid [MPA]) detected in both samples. In 18 months, decline in OTA level was only ~ 3-fold (estimated t½ of ~ 311 days) and decline in MPA level was ~ 11-fold (estimated t½ of ~ 160 days), which was ~ 10- and ~ 213-fold slower than expected in individuals without HLA-DR alleles, respectively. We estimated that ~ 4.3 and ~ 2.2 years will be required for OTA and MPA to reach < LLQ in urine, respectively. Three other subjects with variations in HLA-DR alleles were members of a family who lived in a mold-infested house for 4 years. They kept experiencing mold-related issues >2 years after moving to a non-mold-infested house. Consistent exposure was confirmed by the presence of several mycotoxins in urine >2 years after the secession of higher than background (from outdoor ambient air) exposure. This was consistent with the extremely slow elimination of mycotoxins from their system. Variations in HLA-DR alleles can, consequently, make even short periods of exposure to chronic exposure scenarios with related adverse health effects. It is, therefore, important to determine genetic predisposition as a reason for prolonged/lingering mold-related symptoms long after the cessation of higher than background exposure. Increased human exposure to mycotoxins is expected from increased mold infestation that is anticipated due to rising CO2, temperature, and humidity from the climate change with possibly increased adverse health effects, especially in individuals with genetic susceptibility to mold toxicity.
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Affiliation(s)
- Shakil Ahmed Saghir
- ToxInternational Inc, Hilliard, OH, USA.
- Mold Law Group, Atlanta, GA, USA.
- Department of Biological & Biomedical Sciences, Aga Khan Univ, Karachi, Pakistan.
- Institute of Environmental Science and Meteorology, College of Science, University of the Philippines-Diliman, Quezon City, Philippines.
| | - Rais Ahmed Ansari
- Department of Pharmaceutical Sciences, Barry and Judy Silverman College of Pharmacy, Health Professions Division, Nova Southeastern University, Fort Lauderdale, FL, USA
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Lumkul L, Wongyikul P, Kulalert P, Sompornrattanaphan M, Lao-Araya M, Chuamanochan M, Nochaiwong S, Phinyo P. Genetic association of beta-lactams-induced hypersensitivity reactions: A systematic review of genome-wide evidence and meta-analysis of candidate genes. World Allergy Organ J 2023; 16:100816. [PMID: 37780578 PMCID: PMC10541471 DOI: 10.1016/j.waojou.2023.100816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Importance Beta-lactams (BLs) are the most prescribed antibiotics, being the most frequent cause of drug allergy. However, the association between BL allergy and genetic variations is still unclear. Objective This systematic review and meta-analysis aimed to summarize the genetic effects of BL-induced hypersensitivity using existing evidence. Methods We searched PubMed, Medline, Scopus, EMBASE, CINAHL, and Cochrane Library from inception to September 15, 2022 with no language restriction. Genetic association studies investigating genetic variant/polymorphism and risk of drug-induced hypersensitivity reactions among individuals receiving BL-antibiotics were included. We excluded studies of acute interstitial nephritis, drug-induced liver injury, serum sickness, and isolated drug fever. Data were comprehensively synthesized and quality of study were assessed using STrengthening the Reporting of Genetic Association Studies (STREGA). The record screening, extraction and quality assessment were performed by two reviewers and discussions were made to resolve discrepancies. The effects of each variant were pooled and evaluated by modified Venice criteria. Results A total of 9276 records were identified, and 31 studies were eligible for inclusion. Twenty-seven were candidate-gene association studies (5416 cases and 5939 controls), while the others were next-generation sequencing (NGS) or genome-wide association studies (GWASs) (119 838 cases and 1 487 111 controls). Forty-nine polymorphisms were identified and most of them located in allergic reaction pathways. Meta-analyses of 15 candidate variants in a mixture of both immediate and non-immediate reactions revealed weak genetic effects of rs1801275 (8 studies; n = 1,560; odd ratio 0.73; 95%CI: 0.57-0.93) and rs20541 (4 studies; n = 1,482; odd ratio 1.34; 95%CI: 1.07-1.68) in IL4R and IL13, respectively. Results from GWASs and NGS identified, and confirmed associations in HLA regions including HLA-DRA, HLA-B, HLA-DQA, HLA-DRB1, and HLA-DRB3. Conclusion Our study summarized genetic evidence influencing BL-induced hypersensitivity and estimated effects of potential variants. We postulated that the genomic studies provide better insights to the mechanism of reactions and suggest potential effects of HLA Class II variants. However, results were inconsistent and unable to generalize in different settings. Further high-throughput studies with a well-defined function, epigenetic interaction, incorporated with clinical factors, would be beneficial for risk identification in BL-induced hypersensitivity.
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Affiliation(s)
- Lalita Lumkul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Center of Multidisciplinary Technology for Advanced Medicine (CMUTEAM), Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Pakpoom Wongyikul
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Prapasri Kulalert
- Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani, 12120, Thailand
- Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, 12120, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Mongkol Lao-Araya
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Mati Chuamanochan
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, 50200, Thailand
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Chiang Mai University, Chiang Mai, 50200, Thailand
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Phichayut Phinyo
- Center for Clinical Epidemiology and Clinical Statistics, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
- Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai 50200, Thailand
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Yeo LF, Yi Teong CC, Widjaya M, Ong CY, En Shen Lim CS, Lee SX. Clinical characteristics of patients under General Medicine with drug allergies occurring during hospitalisation at a tertiary hospital. Singapore Med J 2023; 0:367556. [PMID: 36695282 DOI: 10.4103/singaporemedj.smj-2021-089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Li Fang Yeo
- Internal Medicine, Department of General Medicine, Changi General Hospital, Singapore
| | | | | | - Chun Yan Ong
- Department of Pharmacy, Changi General Hospital, Singapore
| | | | - Shan Xian Lee
- Department of Dermatology, Changi General Hospital, Singapore
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Li X, Ren Z, Huang X, Yu T. LACTB, a Metabolic Therapeutic Target in Clinical Cancer Application. Cells 2022; 11:cells11172749. [PMID: 36078157 PMCID: PMC9454609 DOI: 10.3390/cells11172749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/28/2022] [Accepted: 09/01/2022] [Indexed: 11/24/2022] Open
Abstract
Serine beta-lactamase-like protein (LACTB) is the only mammalian mitochondrial homolog evolved from penicillin-binding proteins and β-lactamases (PBP-βLs) in bacteria. LACTB, an active-site serine protease, polymerizes into stable filaments, which are localized to the intermembrane space (IMS) of mitochondrion and involved in the submitochondrial organization, modulating mitochondrial lipid metabolism. Cancer pathogenesis and progression are relevant to the alterations in mitochondrial metabolism. Metabolic reprogramming contributes to cancer cell behavior. This article (1) evidences the clinical implications of LACTB on neoplastic cell proliferation and migration and tumor growth and metastasis as well as LACTB’s involvement in chemotherapeutic and immunotherapeutic responses; (2) sketches the structural basis for LACTB activity and function; and (3) highlights the relevant regulatory mechanisms to LACTB. The abnormal expression of LACTB has been associated with clinicopathological features of cancer tissues and outcomes of anticancer therapies. With the current pioneer researches on the tumor-suppressed function, structural basis, and regulatory mechanism of LACTB, the perspective hints at a great appeal of enzymic property, polymerization, mutation, and epigenetic and post-translational modifications in investigating LACTB’s role in cancer pathogenesis. This perspective provides novel insights for LACTB as a metabolic regulator with potential to develop targeted cancer therapies or neoadjuvant therapeutic interventions.
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Affiliation(s)
- Xiaohua Li
- School of Basic Medical Sciences, Qingdao University, Qingdao 266071, China or
| | - Zhongkai Ren
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, China or
| | - Xiaohong Huang
- Shandong Institute of Traumatic Orthopedics, Medical Research Center, The Affiliated Hospital of Qingdao University, Qingdao 266590, China
- Correspondence: (X.H.); (T.Y.)
| | - Tengbo Yu
- Department of Sports Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266000, China or
- Institute of Sports Medicine and Rehabilitation, Qingdao University, Qingdao 266071, China
- Correspondence: (X.H.); (T.Y.)
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Demirhan A, Yildirim DD, Arikoglu T, Ozhan AK, Tokmeci N, Yuksek BC, Kuyucu S. A combined risk modeling strategy for clinical prediction of beta-lactam allergies in children. Allergy Asthma Proc 2021; 42:e159-e166. [PMID: 34871164 DOI: 10.2500/aap.2021.42.210068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Drug provocation test (DPT) without skin tests is increasingly recommended in the evaluation of children with low-risk beta-lactam (BL) allergies. However, risk definitions are unclear. Objective: The aim of this study was to compose a clinical predictive model that could identify the children at low risk who could safely undergo direct DPT. Methods: The clinical data of 204 children who underwent a full diagnostic algorithm for suspected BL allergy were analyzed. Clinical data were used to construct mathematical predictive model for confirmed BL allergies. A prospective new sample was used for external validation of the final model. Results: The presentations during the index reaction were anaphylaxis in 5.9% and cutaneous reactions in the majority. BL allergy was confirmed in 15.7% of suspected cases. A backward multiple logistic regression model showed that a family history of drug allergy (adjusted odds ratio [aOR], 5.52), anaphylaxis (aOR, 5.14), any atopic disease other than asthma (aOR, 4.38), and a reaction interval of 0-6 hours during the index reaction (aOR, 5.32) were significantly associated with a confirmed BL allergy. A mathematical combined model based on these factors showed a sensitivity of 77.8% and a negative predictive value (NPV) of 94.3%. The validation study replicated sensitivity and NPV values of the main cohort. Conclusion: The risk definition in BL allergies should depend on population-specific predictive models, including a combination of significant risk factors rather than empiric risk approaches. This may help to accurately determinate children at low risk who may safely proceed to direct DPT.
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Affiliation(s)
- Ali Demirhan
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
| | - Didem D. Yildirim
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Tugba Arikoglu
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
| | - Aylin K. Ozhan
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
| | - Nazan Tokmeci
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
| | - Burcu C. Yuksek
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
| | - Semanur Kuyucu
- From the Department of Pediatric Allergy and Clinical Immunology, Faculty of Medicine, Mersin University, Mersin, Turkey, and
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7
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Arikoglu T, Kont AO, Demirhan A, Yuksek BC, Tokmeci N, Kuyucu S. Risk stratification in beta-lactam allergy. CURRENT TREATMENT OPTIONS IN ALLERGY 2021. [DOI: 10.1007/s40521-021-00295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Overview of Beta-Lactam Allergy and the Role of the Pharmacist in Management. ALLERGIES 2021. [DOI: 10.3390/allergies1020011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Unverified beta-lactam allergies are a substantial public health problem, as the majority of patients labeled as beta-lactam allergic do not have clinically significant allergies that may hinder the use beta-lactam therapy when indicated. Outdated or inaccurate beta-lactam or penicillin allergies can result in serious consequences, including suboptimal antibiotic therapy, increased risk of adverse effects, and use of broader spectrum antibiotics than indicated, which may contribute to antimicrobial resistance. The purpose of this review is to provide an overview of beta-lactam allergy and highlight the role of pharmacists in managing beta-lactam allergies. Studies have shown that pharmacists can play a vital role in allergy assessment, penicillin skin testing, beta-lactam desensitization, evaluation of beta-lactam cross-reactivity and recommending appropriate antibiotic therapy in patients with beta-lactam allergies.
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Rosti B, Mahler V. Adding a second skin prick test reading and modifying the cut‐off for beta‐lactam–specific
IgE
enhances the sensitivity in the routine diagnostic workup for immediate beta‐lactam hypersensitivity. Contact Dermatitis 2020; 83:361-371. [DOI: 10.1111/cod.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/21/2020] [Accepted: 05/25/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Bernadette Rosti
- Allergy‐Clinic of the Department of Dermatology University Hospital of Erlangen Erlangen Germany
- Dental Practice Dr. Ludwig and Colleagues MVZ GmbH Fürth Germany
| | - Vera Mahler
- Allergy‐Clinic of the Department of Dermatology University Hospital of Erlangen Erlangen Germany
- Division of Allergology Paul‐Ehrlich‐Institut Langen Germany
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Nicoletti P, Carr DF, Barrett S, McEvoy L, Friedmann PS, Shear NH, Nelson MR, Chiriac AM, Blanca-López N, Cornejo-García JA, Gaeta F, Nakonechna A, Torres MJ, Caruso C, Valluzzi RL, Floratos A, Shen Y, Pavlos RK, Phillips EJ, Demoly P, Romano A, Blanca M, Pirmohamed M. Beta-lactam-induced immediate hypersensitivity reactions: A genome-wide association study of a deeply phenotyped cohort. J Allergy Clin Immunol 2020; 147:1830-1837.e15. [PMID: 33058932 PMCID: PMC8100096 DOI: 10.1016/j.jaci.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND β-lactam antibiotics are associated with a variety of immune-mediated or hypersensitivity reactions, including immediate (type I) reactions mediated by antigen-specific IgE. OBJECTIVE We sought to identify genetic predisposing factors for immediate reactions to β-lactam antibiotics. METHODS Patients with a clinical history of immediate hypersensitivity reactions to either penicillins or cephalosporins, which were immunologically confirmed, were recruited from allergy clinics. A genome-wide association study was conducted on 662 patients (the discovery cohort) with a diagnosis of immediate hypersensitivity and the main finding was replicated in a cohort of 98 Spanish cases, recruited using the same diagnostic criteria as the discovery cohort. RESULTS Genome-wide association study identified rs71542416 within the Class II HLA region as the top hit (P = 2 × 10-14); this was in linkage disequilibrium with HLA-DRB1∗10:01 (odds ratio, 2.93; P = 5.4 × 10-7) and HLA-DQA1∗01:05 (odds ratio, 2.93, P = 5.4 × 10-7). Haplotype analysis identified that HLA-DRB1∗10:01 was a risk factor even without the HLA-DQA1∗01:05 allele. The association with HLA-DRB1∗10:01 was replicated in another cohort, with the meta-analysis of the discovery and replication cohorts showing that HLA-DRB1∗10:01 increased the risk of immediate hypersensitivity at a genome-wide level (odds ratio, 2.96; P = 4.1 × 10-9). No association with HLA-DRB1∗10:01 was identified in 268 patients with delayed hypersensitivity reactions to β-lactams. CONCLUSIONS HLA-DRB1∗10:01 predisposed to immediate hypersensitivity reactions to penicillins. Further work to identify other predisposing HLA and non-HLA loci is required.
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Affiliation(s)
- Paola Nicoletti
- Icahn School of Medicine at Mount Sinai, New York, NY; Sema4, Stamford, Conn
| | - Daniel F Carr
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Barrett
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Laurence McEvoy
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom
| | - Peter S Friedmann
- Dermatology Unit, Sir Henry Wellcome Research Laboratories, School of Medicine, University of Southampton, Southampton, United Kingdom
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Anca M Chiriac
- Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | | | - José A Cornejo-García
- Allergy Research Group, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain
| | - Francesco Gaeta
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Alla Nakonechna
- Liverpool University Hospitals Foundation National Health Service Trust, Liverpool, United Kingdom
| | - Maria J Torres
- Allergy Research Group, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain; Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Cristiano Caruso
- Allergy Unit, Columbus Hospital, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Rocco L Valluzzi
- Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Italy
| | - Aris Floratos
- Department of Systems Biology, New York, NY; Department of Biomedical Informatics, Columbia University, New York, NY
| | | | - Rebecca K Pavlos
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Centre for Clinical Pharmacology and Infectious Diseases, Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Australia
| | - Pascal Demoly
- Division of Allergy, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France; Unité Mixte de Recherche en Santé (UMR-S) 1136 Institut National de la Santé et de la Recherche Médicale-Sorbonne Université, Equipe Epidemiology of allergic and respiratory diseases (EPAR)- Louis d'Epidémiologie et de Santé Publique (IPLESP), Paris, France
| | - Antonino Romano
- Istituto di Ricovero e Cura a Carattere Scientifico Oasi Maria SS, Troina, Italy; Fondazione Mediterranea GB Morgagni, Catania, Italy
| | - Miguel Blanca
- Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain
| | - Munir Pirmohamed
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, United Kingdom; Liverpool University Hospitals Foundation National Health Service Trust, Liverpool, United Kingdom.
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Li PH, Siew LQC, Thomas I, Watts TJ, Ue KL, Rutkowski K, Lau CS. Beta-lactam allergy in Chinese patients and factors predicting genuine allergy. World Allergy Organ J 2019; 12:100048. [PMID: 31692961 PMCID: PMC6822230 DOI: 10.1016/j.waojou.2019.100048] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Beta-lactams (BL) are the most frequently reported drug allergy, but the vast majority of patients are found not to be genuinely allergic after evaluation. Few studies have investigated the clinical predictors of genuine BL allergy, and the prevalence in hospitalized Chinese patients is unknown. Methods Patients admitted to a tertiary hospital in Hong Kong (HK) were analyzed to identify the prevalence and factors associated with the presence of BL allergy labels among hospitalized Chinese patients. A combined cohort of patients having completed allergy investigation for suspected BL allergies in the United Kingdom (UK) and HK were analyzed to identify predictors of genuine allergy. Results The prevalence of BL allergy labels in hospitalized HK Chinese was 5%, which was associated with female gender and concomitant non-BL antibiotic allergy labels. The rate of genuine BL allergy patients referred for suspected allergies in the UK and HK cohort was only 14%. History of anaphylaxis and interval of less than a year since the index reaction were independent clinical predictors of genuine BL allergy. The negative predictive value of penicillin skin testing was 90%, confirming the need for drug provocation testing after negative skin testing. There was a high rate of confirmed piperacillin-tazobactam allergy. Discussion The estimated true prevalence of genuine BL allergy in hospitalized HK Chinese is around 0.5%. This high rate of BL mislabeling highlights the need for comprehensive allergy evaluation and screening. History of anaphylaxis and duration since the index reaction are important predictors of genuine allergy. Piperacillin-tazobactam allergy may pose a unique challenge in this population with a high prevalence of suspected allergies, surging antibiotic resistance, and lack of testing available.
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Affiliation(s)
- Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.,Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Iason Thomas
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Timothy J Watts
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kok Loong Ue
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Krzysztof Rutkowski
- Department of Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chak-Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong
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12
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Collins C. The Low Risks and High Rewards of Penicillin Allergy Delabeling: An Algorithm to Expedite the Evaluation. J Pediatr 2019; 212:216-223. [PMID: 31253408 DOI: 10.1016/j.jpeds.2019.05.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/15/2019] [Accepted: 05/24/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Cathleen Collins
- Division of Allergy Immunology, Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, CA.
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13
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Lee Y, Bradley N. Overview and Insights into Carbapenem Allergy. PHARMACY 2019; 7:pharmacy7030110. [PMID: 31398843 PMCID: PMC6789495 DOI: 10.3390/pharmacy7030110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/20/2022] Open
Abstract
Understanding antibiotic allergies and the risk of cross-sensitivity between and within antibiotic classes can have a substantial impact on patient care. The purpose of this review article is to provide insight into carbapenem allergies, describing the overall incidence, risk factors, and in-class cross-sensitivity. A PubMed search was conducted using the following search terms: carbapenem, allergy, cross-sensitivity, incidence, imipenem/cilastatin, meropenem, ertapenem, and doripenem. Article bibliographies and relevant drug monographs were also reviewed. The overall reported incidence of carbapenem allergy is 0.3%–3.7%. Risk of cross-sensitivity between penicillins and carbapenems is less than 1% in patients with a positive penicillin skin test. Data on cross-sensitivity between cephalosporins and carbapenems are limited; however, the risk appears to also be low. No clinical studies have described cross-sensitivity between the carbapenem agents thus far. The limited data available from case reports demonstrates a lack of cross-sensitivity between the individual carbapenems, suggesting that an alternative carbapenem may cautiously be used in patients with a reported carbapenem allergy.
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Affiliation(s)
- Yuman Lee
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA
| | - Nicole Bradley
- College of Pharmacy and Health Sciences, St. John's University, Queens, NY 11439, USA.
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Lteif L, Eiland LS. The Basics of Penicillin Allergy: What A Clinician Should Know. PHARMACY 2019; 7:E94. [PMID: 31319528 PMCID: PMC6789476 DOI: 10.3390/pharmacy7030094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 12/13/2022] Open
Abstract
Antimicrobials in the penicillin class are first line treatments for several infectious diseases in the pediatric and adult population today. In the United States, patients commonly report having a penicillin allergy, with penicillin being the most frequent beta-lactam allergy. However, very few patients experience a clinically significant immune-mediated allergic reaction to penicillin. If a true penicillin allergy exists, cross-reactivity to other beta-lactam antimicrobials may occur. Mislabeling patients with penicillin allergy can lead to a higher utilization of second line antimicrobial agents, potentially increasing costs and resistance due to a larger spectrum of activity. Pharmacists play an essential role in inquiring about patient specific reactions to presumed medication allergies and developing a further assessment plan, if needed, to determine if the medication allergy is real.
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Affiliation(s)
- Louis Lteif
- System Pharmacy Services, Sharp HealthCare, 8695 Spectrum Center Blvd, San Diego, CA 92123, USA.
| | - Lea S Eiland
- Department of Pharmacy Practice, Harrison School of Pharmacy, Auburn University, 1321 Walker Building, Auburn, AL 36849, USA
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15
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Ge X, Hong JW, Shen JY, Li Z, Zhang R, Wang Q, Ding Z, Chen G, Xu LC. Investigation of candidate genes of non-syndromic cleft lip with or without cleft palate, using both case-control and family-based association studies. Medicine (Baltimore) 2019; 98:e16170. [PMID: 31261547 PMCID: PMC6617431 DOI: 10.1097/md.0000000000016170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE Non-syndromic cleft of the lip and/or palate (NSCL/P) is one of the most common polygenic diseases. In this study, both case-control and family-based association study were used to confirm whether the Single Nucleotide Polymorphisms (SNPs) were associated with NSCL/P. METHODS A total of 37 nuclear families and 189 controls were recruited, whose blood DNA was extracted and subjected to genotyping of SNPs of 27 candidate genes by polymerase chain reaction-improved multiple ligase detection reaction technology (PCR-iMLDR). Case-control statistical analysis was performed using the SPSS 19.0. Haplotype Relative Risk (HRR), transmission disequilibrium test (TDT), and Family-Based Association Test (FBAT) were used to test for over-transmission of the target alleles in case-parent trios. The gene-gene interactions on NSCL/P were analyzed by Unphased-3.1.4. RESULTS In case-control statistical analysis, only C14orf49 chr14_95932477 had statistically significant on genotype model (P = .03) and allele model (P = .03). Seven SNPs had statistically significant on TDT. None of 26 alleles has association with NSCL/P on FBAT. Some SNPs had haplotype-haplotype interactions and genotype-genotype interactions. CONCLUSION C14orf49 chr14_95932477 was significantly different between cases and controls on genotype model and allele model by case-control design. Seven SNPs were significantly different on HRR. Four SNPs were significantly different on TDT.
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16
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Siew LQC, Li PH, Watts TJ, Thomas I, Ue KL, Caballero MR, Rutkowski K, Till SJ, Pillai P, Haque R. Identifying Low-Risk Beta-Lactam Allergy Patients in a UK Tertiary Centre. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2173-2181.e1. [PMID: 30922992 DOI: 10.1016/j.jaip.2019.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 02/19/2019] [Accepted: 03/12/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND There are marked geographical as well as temporal differences in patient sensitization profiles to β-lactams (BL). OBJECTIVE To determine the utility of skin test reagents and identify a cohort of patients where skin testing can be safely omitted in a cohort of patients referred to a UK tertiary referral center. METHODS A retrospective study of the clinical characteristics of 1092 patients referred for BL allergy testing was analyzed using multivariate regression analysis. The effectiveness of skin test reagents was also evaluated. RESULTS Multivariate logistic regression identified that a history of anaphylaxis (odds ratio [OR] 10.98, P = .001) and the patients' recall of the index drug (apart from ampicillin and meropenem, OR 3.51-12.43, P < .05) were independent predictors of type I BL allergic status and a time of less than 1 year elapsed since index reaction significantly increasing the odds of a patient with a history of anaphylaxis, having a type I BL allergy (OR 38.66, P = .003). An absence of anaphylactic severity, unknown name of the index drug and a reaction occurring more than 1 year before testing, has a negative predictive value (NPV) of 98.4%, which was similar to the NPV of skin testing of 98.9% for type I BL allergy. The NPV of skin testing with benzylpenicillin + amoxicillin ± index BL was similar with (98.9%) or without (98.1%) the use of benzylpenicillin polylysine and minor determinant for type I BL allergy. CONCLUSION We identified a "low risk" cohort of patients where the history is of similar reliability to skin testing in predicting nonallergic status for BL allergy.
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Affiliation(s)
- Leonard Quok Chean Siew
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK.
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | - Timothy J Watts
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Iason Thomas
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK
| | - Kok Loong Ue
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK
| | - M Rosario Caballero
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK
| | - Stephen J Till
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK
| | - Prathap Pillai
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK
| | - Rubaiyat Haque
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, UK; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, UK
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17
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Demir S, Erdenen F, Gelincik A, Unal D, Olgac M, Coskun R, Colakoglu B, Buyukozturk S. Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients. Int Arch Allergy Immunol 2018; 178:167-176. [PMID: 30448840 DOI: 10.1159/000494130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/28/2018] [Indexed: 11/19/2022] Open
Abstract
AIM To investigate the potential risk factors in patients who have experienced anaphylaxis from drugs. METHOD The study included 281 adult patients (median age 40 years; 76.5% female) who experienced immediate types of hypersensitivity reaction to a drug. The patients were divided into an anaphylaxis group and a nonanaphylaxis group. The anaphylaxis group was diagnosed according to the criteria of the World Allergy Organization. Skin testing with culprit drugs was performed. In the nonanaphylaxis group, drug provocation tests were performed with culprit drugs, including aspirin or diclofenac, to determine nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. Atopy was determined by skin prick tests with the common inhalant allergens. Patients' demographics, clinical features, and baseline tryptase and total IgE levels were compared between the 2 groups. RESULTS The median interval between the last reaction in the patient's history and the study evaluation was 7 months (range 1-120 months). In 52.3% of the patients, reactions were defined as anaphylaxis. The most common culprit drugs were NSAIDs (56.9%) and β-lactams (34.7%). The culprit drugs were used parenterally in 13.2% of the patients. 34.9% of the patients had comorbid diseases and 24.6% used additional drugs, the most common being antihypertensives (10%). Atopy was determined in 28.8% and 28.1% of the patients were smokers. The median serum level of baseline tryptase and total IgE was 3.5 µg/L and 77 kU/L, respectively. In 46.3% of the patients, skin tests with culprit drugs were positive and the positivity ratio was higher in the anaphylaxis group (p = 0.002). Anapyhlaxis was more common in patients who were: hypertensive, atopic, using angio-tensin-converting enzyme inhibitors/angiotensin receptor blockers, and received the culprit drug parenterally (p = 0.034, p = 0.04, p = 0.03, p = 0.035, p = 0.013, and p < 0.001). In the multivariate analysis, it was observed that the parenteral usage of the drug and the presence of atopy were significantly higher in the anaphylaxis group (p < 0.001, odds ratio [OR] = 20.05, confidence interval [CI] 4.75-88.64; p = 0.012, OR = 2.1, CI 1.17-3.74). Age, smoking, family history, and serum levels of baseline tryptase and total IgE did not differ between groups. CONCLUSION The parenteral route and atopy increase the risk of drug-induced anaphylaxis. IgE-mediated sensitivity to the culprit drug seems to facilitate anaphylaxis.
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Affiliation(s)
- Semra Demir
- Adult Allergy and Immunology Clinic, Istanbul Research and Training Hospital, Health Science University, Istanbul, Turkey,
| | - Fusun Erdenen
- Adult Allergy and Immunology Clinic, Istanbul Research and Training Hospital, Health Science University, Istanbul, Turkey
| | - Asli Gelincik
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Derya Unal
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Muge Olgac
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Raif Coskun
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahauddin Colakoglu
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Suna Buyukozturk
- Division of Immunology and Allergic Diseases, Department of Internal Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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18
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Tomasiak-Łozowska MM, Klimek M, Lis A, Moniuszko M, Bodzenta-Łukaszyk A. Markers of anaphylaxis - a systematic review. Adv Med Sci 2018; 63:265-277. [PMID: 29486376 DOI: 10.1016/j.advms.2017.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 12/14/2017] [Accepted: 12/17/2017] [Indexed: 12/11/2022]
Abstract
Anaphylaxis is defined as severe, life-threatening, systemic or general, immediate reaction of hypersensitivity, with repeatable symptoms caused by the dose of stimulus which is well tolerated by healthy persons. The proper diagnosis, immediate treatment and differential diagnosis are crucial for saving patient's life. However, anaphylaxis is relatively frequently misdiagnosed or confused with other clinical entities. Thus, there is a continuous need for identifying detectable markers improving the proper diagnosis of anaphylaxis. Here we presented currently known markers of anaphylaxis and discussed in more detail the most clinically valuable ones: tryptase, platelet activacting factor (PAF), PAF-acethylhydrolase, histamine and its metabolites.
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19
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An Updated Review of the Molecular Mechanisms in Drug Hypersensitivity. J Immunol Res 2018; 2018:6431694. [PMID: 29651444 PMCID: PMC5830968 DOI: 10.1155/2018/6431694] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 11/09/2017] [Indexed: 02/07/2023] Open
Abstract
Drug hypersensitivity may manifest ranging from milder skin reactions (e.g., maculopapular exanthema and urticaria) to severe systemic reactions, such as anaphylaxis, drug reactions with eosinophilia and systemic symptoms (DRESS)/drug-induced hypersensitivity syndrome (DIHS), or Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). Current pharmacogenomic studies have made important strides in the prevention of some drug hypersensitivity through the identification of relevant genetic variants, particularly for genes encoding drug-metabolizing enzymes and human leukocyte antigens (HLAs). The associations identified by these studies are usually drug, phenotype, and ethnic specific. The drug presentation models that explain how small drug antigens might interact with HLA and T cell receptor (TCR) molecules in drug hypersensitivity include the hapten theory, the p-i concept, the altered peptide repertoire model, and the altered TCR repertoire model. The broad spectrum of clinical manifestations of drug hypersensitivity involving different drugs, as well as the various pathomechanisms involved, makes the diagnosis and management of it more challenging. This review highlights recent advances in our understanding of the predisposing factors, immune mechanisms, pathogenesis, diagnostic tools, and therapeutic approaches for drug hypersensitivity.
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20
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Pongdee T, Li JT. Evaluation and Management of Penicillin Allergy. Mayo Clin Proc 2018; 93:101-107. [PMID: 29304914 DOI: 10.1016/j.mayocp.2017.09.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 11/23/2022]
Abstract
Penicillin allergy is the most commonly reported drug allergy in the United States. Although penicillin allergy is widely reported, 80% to 90% of individuals with self-reported penicillin allergy are actually able to tolerate penicillins after undergoing evaluation for penicillin allergy. Because most patients with self-reported penicillin allergy will have subsequent negative allergy testing results and tolerate penicillins, they may be unnecessarily exposed to broader-spectrum antibiotics. Use of such antibiotics leads to increased risks of developing antibiotic-resistant microorganisms and incur higher health care utilization costs. In this article, we provide an overview of penicillin allergy and its clinical manifestations as well as an approach for the evaluation and management of penicillin allergy.
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Affiliation(s)
- Thanai Pongdee
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| | - James T Li
- Division of Allergic Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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21
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Abstract
Ten percent of patients report penicillin allergy, but more than 90% of these individuals can tolerate penicillins. Skin testing remains the optimal method for evaluation of possible IgE-mediated penicillin allergy and is recommended by professional societies, as the harms for alternative antibiotics include antimicrobial resistance, prolonged hospitalizations, readmissions, and increased costs. Removal of penicillin allergy leads to decreased utilization of broad-spectrum antibiotics, such as fluoroquinolones and vancomycin. There is minimal allergic cross-reactivity between penicillins and cephalosporins. IgE-mediated allergy to cephalosporins is usually side-chain specific and may warrant graded challenge with cephalosporins containing dissimilar R1 or R2 group side chains.
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Affiliation(s)
- Daniel Har
- Division of Allergy and Immunology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
| | - Roland Solensky
- Division of Allergy and Immunology, The Corvallis Clinic, 3680 NW Samaritan Dr, Corvallis, OR 97330, USA; Oregon State University/Oregon Health & Science University College of Pharmacy, 1601 SW Jefferson Way, Corvallis, OR 97331, USA.
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22
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Reber LL, Hernandez JD, Galli SJ. The pathophysiology of anaphylaxis. J Allergy Clin Immunol 2017; 140:335-348. [PMID: 28780941 PMCID: PMC5657389 DOI: 10.1016/j.jaci.2017.06.003] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 01/14/2023]
Abstract
Anaphylaxis is a severe systemic hypersensitivity reaction that is rapid in onset; characterized by life-threatening airway, breathing, and/or circulatory problems; and usually associated with skin and mucosal changes. Because it can be triggered in some persons by minute amounts of antigen (eg, certain foods or single insect stings), anaphylaxis can be considered the most aberrant example of an imbalance between the cost and benefit of an immune response. This review will describe current understanding of the immunopathogenesis and pathophysiology of anaphylaxis, focusing on the roles of IgE and IgG antibodies, immune effector cells, and mediators thought to contribute to examples of the disorder. Evidence from studies of anaphylaxis in human subjects will be discussed, as well as insights gained from analyses of animal models, including mice genetically deficient in the antibodies, antibody receptors, effector cells, or mediators implicated in anaphylaxis and mice that have been "humanized" for some of these elements. We also review possible host factors that might influence the occurrence or severity of anaphylaxis. Finally, we will speculate about anaphylaxis from an evolutionary perspective and argue that, in the context of severe envenomation by arthropods or reptiles, anaphylaxis might even provide a survival advantage.
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Affiliation(s)
- Laurent L Reber
- Department of Immunology, Unit of Antibodies in Therapy and Pathology, Institut Pasteur, Paris, France; Institut National de la Santé et de la Recherche Médicale, Paris, France; Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif
| | - Joseph D Hernandez
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, Calif
| | - Stephen J Galli
- Department of Pathology, Stanford University School of Medicine, Stanford, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Stanford, Calif; Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, Calif.
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23
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Gomes ER, Kuyucu S. Epidemiology and Risk Factors in Drug Hypersensitivity Reactions. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0128-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Penicillini allergy is a potentially serious adverse reaction that impacts on antibacterial treatment options. Although it is commonly reported and recorded in medical records, only a minority of patients with a label of penicillin allergy actually have the condition confirmed. The term 'allergy' may be incorrectly applied to adverse reactions that do not have an immunological basis and inappropriate labelling of penicillin allergy can lead to the unnecessary avoidance of penicillins and other beta-lactam antibacterials. Here, we discuss key features that help to distinguish patients at low or high risk of having a true penicillin allergy, summarise what is known about the risk of allergic reactions to other beta-lactam antibacterials in patients with penicillin allergy and discuss the steps to consider when assessing a label of penicillin allergy.
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25
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Dodiuk-Gad RP, Chung WH, Shear NH. Adverse Medication Reactions. CLINICAL AND BASIC IMMUNODERMATOLOGY 2017. [PMCID: PMC7123512 DOI: 10.1007/978-3-319-29785-9_25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cutaneous adverse drug reactions (ADRs) are among the most frequent adverse reactions in patients receiving drug therapy. They have a broad spectrum of clinical manifestations, are caused by various drugs, and result from different pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Severe cutaneous ADRs comprise a group of diseases with major morbidity and mortality, reaching 30 % mortality rate in cases of Toxic Epidermal Necrolysis. This chapter covers the terminology, epidemiology, pathogenesis and classification of cutaneous ADR, describes the severe cutaneous ADRs and the clinical and laboratory approach to the patient with cutaneous ADR and presents the translation of laboratory-based discoveries on the genetic predisposition and pathogenesis of cutaneous ADRs to clinical management guidelines.
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26
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Khan DA. Pharmacogenomics and adverse drug reactions: Primetime and not ready for primetime tests. J Allergy Clin Immunol 2016; 138:943-955. [DOI: 10.1016/j.jaci.2016.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/24/2016] [Accepted: 08/24/2016] [Indexed: 10/20/2022]
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27
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Oussalah A, Mayorga C, Blanca M, Barbaud A, Nakonechna A, Cernadas J, Gotua M, Brockow K, Caubet JC, Bircher A, Atanaskovic M, Demoly P, K. Tanno L, Terreehorst I, Laguna JJ, Romano A, Guéant JL. Genetic variants associated with drugs-induced immediate hypersensitivity reactions: a PRISMA-compliant systematic review. Allergy 2016; 71:443-62. [PMID: 26678823 DOI: 10.1111/all.12821] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 12/31/2022]
Abstract
Drug hypersensitivity includes allergic (AR) and nonallergic reactions (NARs) influenced by genetic predisposition. We performed a systematic review of genetic predictors of IgE-mediated AR and NAR with MEDLINE and PubMed search engine between January 1966 and December 2014. Among 3110 citations, the search selected 53 studies, 42 of which remained eligible. These eligible studies have evaluated genetic determinants of immediate reactions (IR) to beta-lactams (n = 19), NAR against aspirin (n = 12) and other nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 8), and IR to biologics (n = 3). We reported two genomewide association studies and four case-control studies on candidate genes validated by replication. Genes involved in IR to beta-lactams belonged to HLA type 2 antigen processing, IgE production, atopy, and inflammation, including 4 genes validated by replications, HLA-DRA, ILR4, NOD2, and LGALS3. Genes involved in NAR to aspirin belonged to arachidonic acid pathway, membrane-spanning 4A gene family, histamine production pathway, and pro-inflammatory cytokines, while those involved in NAR to all NSAIDs belonged to arachidonic acid pathway and HLA antigen processing pathway. ALOX5 was a common predictor of studies on NAR to both aspirin and NSAIDs. Although these first conclusions could be drawn, this review highlights also the lack of reliable data and the need for replicating studies in contrasted populations, taking into account worldwide allele frequencies, gene-gene interactions, and contrasted situations of environmental exposure.
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Affiliation(s)
- A. Oussalah
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - C. Mayorga
- Research Laboratory; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; UMA; Malaga Spain
| | - A. Barbaud
- Department of Dermatology and Allergology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - A. Nakonechna
- Allergy and Immunology; Clinic Royal Liverpool and Broadgreen University Hospital; Thomas Drive Liverpool UK
| | - J. Cernadas
- Immunoallergy Department; Centro Hospitalar Sao Joao; Porto Portugal
| | - M. Gotua
- Center for Allergy and Immunology Research; Tbilisi Georgia
| | - K. Brockow
- Klinik für Dermatologie und Allergologie am Biederstein; Technische Universität München; München Germany
| | - J.-C. Caubet
- Division of Paediatrics; University Hospital of Geneva; Geneva Switzerland
| | - A. Bircher
- Dermatologie/Allergologie; Universitätsspital Basel; Basel Switzerland
| | - M. Atanaskovic
- Department of Allergology and Pulmonology; University Children's Hospital; Belgrade Serbia
| | - P. Demoly
- Department of Pulmonology; Division of Allergy; Hôpital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
| | | | - I. Terreehorst
- Academisch Medisch Centrum; University of Amsterdam; Amsterdam Netherlands
| | - J. J. Laguna
- Allergy Unit; Hospital de la Cruz Roja and Department of Immunology Alfonso X el Sabio University; Madrid Spain
| | - A. Romano
- Allergy Unit; Complesso Integrato Columbus, Rome and IRCCS Oasi Maria S.S.; Troina Italy
| | - J.-L. Guéant
- Faculty of Medicine of Nancy; NGERE - Nutrition, Genetics and Environmental Risk Exposure; INSERM U954; University of Lorraine; Vandoeuvre-lès-Nancy France
- Department of Molecular Medicine and Personalized Therapeutics; Department of Biochemistry, Molecular Biology, Nutrition and Metabolism; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
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Luo Z, Shu H, Guo P, Zheng P, Pan X, Du W, Liu R, Zeng A, Chang C, Fu Q. Study of the allergenic benzypenicilloyl–HSA and its specific separation from human plasma by a pre-designed hybrid imprinted membrane. RSC Adv 2016. [DOI: 10.1039/c5ra24322j] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The proposed principle of preparation of CPC-MIM.
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Affiliation(s)
- Zhimin Luo
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Hua Shu
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Pengqi Guo
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Penglei Zheng
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Xiaoyan Pan
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Wei Du
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Ruilin Liu
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Aiguo Zeng
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Chun Chang
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
| | - Qiang Fu
- School of Pharmacy
- Xi'an Jiaotong University
- Xi'an
- PR China
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Moskow JM, Cook N, Champion-Lippmann C, Amofah SA, Garcia AS. Identifying opportunities in EHR to improve the quality of antibiotic allergy data. J Am Med Inform Assoc 2015; 23:e108-12. [PMID: 26554427 DOI: 10.1093/jamia/ocv139] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 07/30/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a growing, global public health crisis, due in large part to the overuse and misuse of antibiotics. Understanding medication allergy data and allergy reactions that are documented in electronic health records (EHRs) can help to identify opportunities to improve the quality of documentation of beta-lactam allergies, thus potentially reducing the prescribing of alternative antibiotics. METHODS Medication allergies and allergy reactions recorded in the EHR for 319 051 patients seen across 32 community health centers were reviewed. Patients with a beta-lactam allergy recorded in their EHR were identified. Free text, as well as standardized allergy and allergy reaction fields, were analyzed. RESULTS Among patients, 9.1% (n = 29 095) had evidence of a beta-lactam allergy recorded in their EHR. Women, white, and non-Hispanic patients were more likely to have a documented allergy compared to men, black, and Hispanic patients. Among all patients with a documented beta-lactam allergy, 36.2% had an empty or missing allergy reaction description in their EHR. CONCLUSIONS Findings suggest that current EHR documentation practices among the health centers reviewed do not provide enough information on allergic reactions to allow providers to discern between true allergies and common, but anticipated, drug side effects. Improved EHR documentation guidance, training that reinforces the use of standardized data and more detailed recording of allergic reactions, combined with initiatives to address patient barriers including health literacy, may help to improve the accuracy of drug allergies in patients' records. These initiatives, combined with antimicrobial stewardship programs, can help to reduce inappropriate prescribing of alternative antibiotics when beta-lactam antibiotics are first-line and can be tolerated.
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Affiliation(s)
- Jaclynn M Moskow
- Clinical Instructor of Public Health, Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program
| | - Nicole Cook
- Assistant Professor of Public Health, Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program, Fort Lauderdale, FL, USA
| | - Carisa Champion-Lippmann
- Nova Southeastern University College of Osteopathic Medicine, Master of Public Health Program, Fort Lauderdale, FL, USA
| | - Saint Anthony Amofah
- Chief Medical Officer, Community Health of South Florida and Health Choice Network, Inc. Miami, FL, USA
| | - Angela S Garcia
- Associate Professor of Pharmacy, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
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Mirakian R, Leech SC, Krishna MT, Richter AG, Huber PAJ, Farooque S, Khan N, Pirmohamed M, Clark AT, Nasser SM. Management of allergy to penicillins and other beta-lactams. Clin Exp Allergy 2015; 45:300-27. [PMID: 25623506 DOI: 10.1111/cea.12468] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 12/15/2022]
Abstract
The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.
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Affiliation(s)
- R Mirakian
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Li J, Liu XY, Li LJ, You CG, Shi L, Zhang SD, Liu Q, Wang J, Liu ZJ, Lv TH. Correlation analysis of gene polymorphisms and β-lactam allergy. J Zhejiang Univ Sci B 2015; 16:632-9. [PMID: 26160721 DOI: 10.1631/jzus.b1400309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A total of 64 patients with β-lactam allergy and 30 control subjects were enrolled in a case-control study. This study is aimed to analyze the relationship between β-lactam allergy and 10 single nucleotide polymorphisms (SNPs) in interleukin-10 (IL-10), IL-13, IL-4Rα, high-affinity immunoglobulin E-receptor β chain (FcεRIβ), interferon γ receptor 2 (IFNGR2), and CYP3A4, and within the Han Chinese population of Northwest China. Genotyping for the SNPs was conducted using the Sequenom MassARRAY(®) platform. SPSS 17.0 was employed to analyze the statistical data and SHEsis was used to perform the haplotype reconstruction and analyze linkage disequilibrium of SNPs of IL-10 and IL-13. The results showed that the genotype distribution of CYP3A4 rs2242480/CT differed significantly between case and control groups of males (P=0.022; odds ratio (OR)=0.167, 95% confidence interval (CI): 0.032-0.867). Further analysis showed that CCA, CCG, and TAA haplotypes of IL-10 had no significant correlation in patients with β-lactam allergy. The correlation between CCT and CAC haplotypes of IL-13 and β-lactam allergy needs to be further studied. The analysis did not reveal any differences in the distribution of others gene polymorphisms between cases and controls.
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Affiliation(s)
- Jing Li
- Centre of Laboratory Medicine, Lanzhou University Second Hospital, Lanzhou 730030, China; School of Basic Medical Science, Lanzhou University, Lanzhou 730030, China
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Guéant JL, Romano A, Cornejo-Garcia JA, Oussalah A, Chery C, Blanca-López N, Guéant-Rodriguez RM, Gaeta F, Rouyer P, Josse T, Canto G, Carmona FD, Bossini-Castillo L, Martin J, Laguna JJ, Fernandez J, Feo F, Ostrov DA, Plasencia PC, Mayorga C, Torres MJ, Blanca M. HLA-DRA variants predict penicillin allergy in genome-wide fine-mapping genotyping. J Allergy Clin Immunol 2015; 135:253-9. [DOI: 10.1016/j.jaci.2014.07.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/09/2014] [Accepted: 07/17/2014] [Indexed: 01/05/2023]
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33
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Cherednichenko AA, Trifonova EA, Vagaitseva KV, Bocharova AV, Stepanov VA. Association of the genenetic polymorphism of cytokines and their receptors with climate and geographic factors in human populations. RUSS J GENET+ 2014. [DOI: 10.1134/s1022795414100020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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34
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Bursztejn AC, Romano A, Guéant-Rodriguez RM, Cornejo JA, Oussalah A, Chery C, Gastin I, Gaeta F, Barbaud A, Blanca M, Guéant JL. Allergy to betalactams and nucleotide-binding oligomerization domain (NOD) gene polymorphisms. Allergy 2013; 68:1076-80. [PMID: 23888881 DOI: 10.1111/all.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Polymorphisms of interleukin genes related to IgE production and inflammation are predictors of hypersensitivity to betalactam, but nothing is known on the influence of NOD genes, despite their association with inflammation and atopy. OBJECTIVE To evaluate the association of NOD2 and NOD1 polymorphisms with betalactam allergy. METHOD We genotyped 3 polymorphisms of NOD2 and 1 of NOD1 in 368 Italian and 387 Spanish patients, compared with 368 and 326 controls, respectively. RESULTS CT/TT genotypes of rs2066845 of NOD2 predicted a lower risk in Italy (P = 0.003), while WT/insC genotype of rs5743293 (also in leucine-rich repeat domain) predicted a higher risk in Spain (P = 0.007). G allele of rs2066845 was associated with a higher level of IgE in the Italian population. CONCLUSION The mirrored influence of these NOD2 polymorphisms on betalactam allergy in two populations suggests a link with pathways of inflammation and/or atopy through mechanisms, which need to be clarified.
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Affiliation(s)
| | | | - R. M. Guéant-Rodriguez
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - J. A. Cornejo
- Research Laboratory for Allergic Diseases and Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - A. Oussalah
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - C. Chery
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - I. Gastin
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
| | - F. Gaeta
- Allergy Unit; Complesso Integrato Columbus; Rome
| | | | - M. Blanca
- Research Laboratory for Allergic Diseases and Allergy Service; Carlos Haya Hospital; Malaga; Spain
| | - J. L. Guéant
- Inserm U954 N-GERE (Nutrition-Génétique-Exposition aux risques environnementaux); Faculté de Médecine et Centre Hospitalier Universitaire; Université de Lorraine; Nancy
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35
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Sornwatana T, Roytrakul S, Wetprasit N, Ratanapo S. Brucin, an antibacterial peptide derived from fruit protein of Fructus Bruceae, Brucea javanica
(L.) Merr. Lett Appl Microbiol 2013; 57:129-36. [DOI: 10.1111/lam.12085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 04/11/2013] [Accepted: 04/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
- T. Sornwatana
- Department of Biochemistry, Faculty of Science; Kasetsart University; Bangkok Thailand
| | - S. Roytrakul
- National Center for Genetic Engineering and Biotechnology; National Science and Technology Development Agency (NSTDA); Pathum Thani Thailand
| | - N. Wetprasit
- Department of Biotechnology; Faculty of Science; Ramkhamhaeng University; Bangkok Thailand
| | - S. Ratanapo
- Department of Biochemistry, Faculty of Science; Kasetsart University; Bangkok Thailand
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36
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Aimone-Gastin I. Prédispositions génétiques aux réactions d’HS allergiques aux médicaments. REVUE FRANÇAISE D'ALLERGOLOGIE 2013. [DOI: 10.1016/j.reval.2013.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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37
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Barbaud A, Waton J, Herbeth B, Bursztejn A, Bollaert M, Schmutz J, Guéant-Rodriguez R, Namour F, Guéant J, Aimone-Gastin I. Comparison of cytokine gene polymorphism in drug-induced maculopapular eruption, urticaria and drug reaction with eosinophilia and systemic symptoms (DRESS). J Eur Acad Dermatol Venereol 2013; 28:491-9. [DOI: 10.1111/jdv.12130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 02/04/2013] [Indexed: 12/21/2022]
Affiliation(s)
- A. Barbaud
- CHU Nancy; Service de Dermatologie and INGRES research Unit; pôle des Spécialités médicales; Vandoeuvre les Nancy; France
- INSERM; U954; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
| | - J. Waton
- CHU Nancy; Service de Dermatologie and INGRES research Unit; pôle des Spécialités médicales; Vandoeuvre les Nancy; France
| | - B. Herbeth
- CHU Nancy; Laboratoire de Biochimie et Biologie Moléculaire; Nutrition et Métabolisme; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Pharmacie; Nancy France
| | - A.C. Bursztejn
- CHU Nancy; Service de Dermatologie and INGRES research Unit; pôle des Spécialités médicales; Vandoeuvre les Nancy; France
- INSERM; U954; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
| | - M. Bollaert
- CHU Nancy; Service de Dermatologie and INGRES research Unit; pôle des Spécialités médicales; Vandoeuvre les Nancy; France
| | - J.L. Schmutz
- CHU Nancy; Service de Dermatologie and INGRES research Unit; pôle des Spécialités médicales; Vandoeuvre les Nancy; France
| | - R.M. Guéant-Rodriguez
- INSERM; U954; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
- CHU Nancy; Laboratoire de Biochimie et Biologie Moléculaire; Nutrition et Métabolisme; Vandoeuvre les Nancy; France
| | - F. Namour
- INSERM; U954; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
- CHU Nancy; Laboratoire de Biochimie et Biologie Moléculaire; Nutrition et Métabolisme; Vandoeuvre les Nancy; France
| | - J.L. Guéant
- INSERM; U954; Vandoeuvre les Nancy; France
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
- CHU Nancy; Laboratoire de Biochimie et Biologie Moléculaire; Nutrition et Métabolisme; Vandoeuvre les Nancy; France
| | - I. Aimone-Gastin
- Université de Lorraine; Faculté de Médecine; Vandoeuvre les Nancy; France
- CHU Nancy; Laboratoire de Biochimie et Biologie Moléculaire; Nutrition et Métabolisme; Vandoeuvre les Nancy; France
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38
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Nam YH, Kim JE, Kim SH, Jin HJ, Hwang EK, Shin YS, Ye YM, Park HS. Identifying genetic susceptibility to sensitization to cephalosporins in health care workers. J Korean Med Sci 2012; 27:1292-9. [PMID: 23166408 PMCID: PMC3492661 DOI: 10.3346/jkms.2012.27.11.1292] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 08/27/2012] [Indexed: 12/21/2022] Open
Abstract
Exposure to cephalosporins could cause occupational allergic diseases in health care workers (HCWs). We evaluated the prevalence of serum specific IgE and IgG antibodies to cephalosporin-human serum albumin (HSA) conjugate and to identify potential genetic risk factors associated with sensitization to cephalosporins in exposed HCWs. The study population consisted of 153 HCWs who had been exposed to antibiotics in a single university hospital and 86 unexposed healthy controls. A questionnaire survey of work-related symptoms (WRS) was administered. A skin-prick test (SPT) was performed, and serum-specific IgE and IgG antibodies to 3 commonly prescribed cephalosporins were measured by ELISA. Four single-nucleotide polymorphisms of the candidate genes related to IgE sensitization were genotyped. The prevalence of WRS to cephalosporins was 2.6%. The prevalence rates of serum-specific IgE and IgG antibodies to cephalosporins were 20.3% and 14.7%, respectively. The FcεR1β-109T > C polymorphism was significantly associated with IgE sensitization to cephalosporins in HCWs (P = 0.036, OR = 3.553; CI, 1.324-9.532). The in vitro functional assay demonstrated that the T allele of FcεR1β-109T had greater promoter activity than did the C allele (P < 0.001). The FcεR1β-109T > C polymorphism may be a potential genetic risk factor for increased IgE sensitization to cephalosporins.
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Affiliation(s)
- Young-Hee Nam
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Jeong-Eun Kim
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung-Hyun Kim
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hyun Jung Jin
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Eui-Kyung Hwang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Seob Shin
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Cornejo-García JA, Guéant-Rodriguez RM, Torres MJ, Blanca-Lopez N, Tramoy D, Romano A, Blanca M, Guéant JL. Biological and genetic determinants of atopy are predictors of immediate-type allergy to betalactams, in Spain. Allergy 2012; 67:1181-5. [PMID: 22764749 DOI: 10.1111/j.1398-9995.2012.02867.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Betalactam (BL) immediate-type allergy is influenced by environmental and genetic determinants, as illustrated by differences in worldwide prevalence and ethnicity from a same area and by associations with genes related to atopy. AIMS To evaluate the association of atopy with BL allergy. MATERIALS AND METHODS We measured specific Immunoglobulin E (IgE) against prevalent allergens and genetic predictors of atopy, IL13, IL4, IL4RA, IL4, and TNFA, in 340 patients and 340 controls from South of Spain. RESULTS Total IgE and IgE against mites were at higher concentration in patients. Patients with high total IgE and IgE against prevalent allergens had a slower decrease in BL IgE than nonatopic patients. IL4RA I50V and Q551R were associated with IgE against prevalent allergens and total IgE, respectively, and were also predictors of BL allergy. CONCLUSION Interacting determinants of atopy, total IgE, IgE against prevalent allergens, and IL4RA polymorphisms, contribute to the high prevalence of BL allergy in South of Spain.
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Affiliation(s)
| | - R.-M. Guéant-Rodriguez
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
| | - M. J. Torres
- Servicio de Alergia; Hospital Carlos Haya; Málaga; Spain
| | - N. Blanca-Lopez
- Laboratorio de Investigación; Hospital Carlos Haya-Fundación IMABIS; Málaga; Spain
| | - D. Tramoy
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
| | - A. Romano
- Unità di Allergologia; Complesso Integrato Columbus; Rome; Italy
| | | | - J.-L. Guéant
- Inserm U954 (Institut National de la Santé et de la Recherche Médicale); Nutrition-Génétique-Exposition aux risques environnementaux; Faculté de Médecine et Centre Hospitalier Universitaire; Nancy-Université; Nancy; France
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Chen G, Zhou D, Zhang Z, Kan M, Zhang D, Hu X, Feng G, Liu Y, He L. Genetic variants in IFIH1 play opposite roles in the pathogenesis of psoriasis and chronic periodontitis. Int J Immunogenet 2011; 39:137-43. [PMID: 22152027 DOI: 10.1111/j.1744-313x.2011.01068.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The IFIH1 gene is a key factor connecting environmental and genetic factors in the pathogenesis of immune-related diseases. We aimed to investigate whether it has effects on psoriasis, chronic periodontitis and skin test-positive penicillin allergy and to confirm whether these diseases have shared molecular mechanisms originating from shared genetics. Two common variants in IFIH1 were genotyped in 561 patients with psoriasis, 421 patients with chronic periodontitis, 175 patients with skin test-positive penicillin allergy and 1100 shared controls. Then, case-control study was used to analyse the association between IFIH1 and the three diseases. The allele distributions of rs1990760 and rs3747517 in the Chinese population are much different from the European population. The A allele of rs1990760 (OR = 1.30, P = 5.4 × 10(-3)) and A-G (rs1990760/rs3747517) haplotype (OR = 1.31, P = 3.8 × 10(-3)) were highly associated with the risk of psoriasis. However, the A allele of rs1990760 (OR = 0.73, P = 7.8 × 10(-3)) and A-G haplotype (OR = 0.71, P = 4.5 × 10(-3)) were identified as protective factors for chronic periodontitis. IFIH1 affects several immune-related diseases, including psoriasis and chronic periodontitis, and provides a molecular link between genetic susceptibility, viral infections and immune-related diseases. Moreover, we also confirm the hypothesis that shared molecular mechanisms from common genetic variants contribute to a spectrum of immune-related diseases.
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Affiliation(s)
- G Chen
- Division of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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41
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Ming L, Wen Q, Qiao HL, Dong ZM. Interleukin-18 and IL18 -607A/C and -137G/C gene polymorphisms in patients with penicillin allergy. J Int Med Res 2011; 39:388-98. [PMID: 21672342 DOI: 10.1177/147323001103900206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study investigated the association between polymorphisms (-607A/C and -137G/C) in the promoter region of the IL18 gene (which encodes interleukin [IL]-18) and serum levels of IL-18, using standard genotyping techniques (sequence specific primer-polymerase chain reaction) and an enzyme-linked immunosorbent assay, respectively, in patients allergic to penicillin. A higher frequency of A alleles and the AA genotype was found at position -607A/C in patients allergic to penicillin than in control subjects. For the -137G/C position, the C allele was more frequent in patients allergic to penicillin than in control subjects. Haplotype analysis showed that the -607A/-137C haplotype was more frequent in patients allergic to penicillin than in control subjects. The patients had a significantly higher serum IL-18 level than the control subjects. In conclusion, IL18 -607A/C and -137G/C promoter polymorphisms are associated with susceptibility to penicillin allergy. In particular, the -137G/C position appears to play an important role in IL18 expression.
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Affiliation(s)
- L Ming
- Department of Clinical Pharmacology, School of Medicine, Zhengzhou University, Zhengzhou, Henan, China
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Holm A, Mosbech H. Challenge Test Results in Patients With Suspected Penicillin Allergy, but No Specific IgE. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2011; 3:118-22. [PMID: 21461251 PMCID: PMC3062790 DOI: 10.4168/aair.2011.3.2.118] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 10/18/2010] [Indexed: 11/20/2022]
Abstract
Purpose Patients with a history of allergic reaction to penicillin, but with no detectable specific IgE, are common and pose a dilemma. Challenge tests are considered to be the diagnostic gold standard. The aim of this study was to identify subgroups of patients with very low risk for reactions who could be safely tested using a more rapid and simple procedure. Methods A total of 580 consecutively referred adult patients with a history of non-serious cutaneous allergic reactions to penicillin, but with no IgE, were challenged with therapeutic doses of penicillin V (phenoxymethylpenicillin), penicillin G (benzylpenicillin), or both. Results Only 14 of 580 patients had a positive challenge test. In 11 of the 14, a reaction to challenge occurred within 2 hours, and none were anaphylactic. The year of the original reaction was known for 555 patients; a positive challenge was seen in only 0.4% of those with an original reaction >15 years before challenge, but in 4.6% of those with a more recent original reaction (P=0.001). Onset of a reaction within the first day of the original exposure was a predictive factor for a positive challenge (P=0.001) in patients challenged within 15 years of the original reaction. Conclusions Among suspected penicillin-allergic patients with non-severe skin reactions and no detectable specific IgE, the subgroup of patients who originally reacted more than 15 years previously had very low risk for reacting to a challenge. The risk was higher in patients with a more recent original reaction, especially if the symptoms had occurred within the first day of exposure.
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Affiliation(s)
- Anne Holm
- Allergy Unit, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Immediate-type drug hypersensitivity and associated factors in a general population. Allergol Immunopathol (Madr) 2011; 39:27-31. [PMID: 20675031 DOI: 10.1016/j.aller.2010.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 02/02/2010] [Accepted: 02/08/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our aim was to assess the prevalence and associated risk factors of common hypersensitivity reactions to drugs in the adult population, for which limited data are available. METHODS The data consisted of 1052 questionnaires obtained from adults. The questionnaires consisted of questions on immediate-type hypersensitivity reactions induced by drugs (itching, skin rash/hives, angio-oedema, shortness of breath, hypotension, and loss of consciousness). The questionnaire added knowledge on physician's diagnosis of asthma, allergic rhinitis, eczema, and other chronic systemic diseases. RESULTS The prevalence of self-reported drug hypersensitivity reactions was 11.8% for all reactions. Hypersensitivity reactions to analgesics were the most common (37.2%) followed by antibiotics (24.2%). Multivariate analysis showed that female gender (Odds Ratio (OR) 95% Confidence Interval (CI) (2.00 (1.25-3.21)), physician-diagnosed allergic rhinitis (3.03 (1.64-5.59)), and eczema (3.22 (1.87-5.53)) were associated with any type of drug hypersensitivity reactions. Itching was associated with allergic rhinitis (4.50 (2.06-9.81)) and eczema diagnosis (4.24 (2.14-8.64)). Skin rash/hives were associated with female gender (2.67 (1.24-5.74)), allergic rhinitis (4.57 (1.99-10.05)), and eczema (5.36 (2.65-10.84)). Angio-oedema was higher in females (5.74 (1.69-18.5)). In addition, eczema (2.87 (1.12-7.32)) and systemic hypertension (2.60(1.03-6.10)) were associated with angio-oedema. Shortness of breath was only associated with ever asthma diagnosis (6.59 (2.09-20.83)). Factors associated with loss of consciousness were female gender (5.56 (1.27-24.30)), allergic rhinitis diagnosis (4.76 (1.73-13.14)), and systemic hypertension (2.74 (1.02-7.41)). CONCLUSION The study showed that females and subjects with allergic diseases and hypertension were more susceptible to drug hypersensitivity reactions.
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Abstract
Anaphylaxis is a clinical emergency, and recent reports suggest increased prevalence. A diverse set of primary genetic and environmental influences may confer susceptibility to anaphylactic reactions. Anaphylaxis presents diagnostic and therapeutic challenges. It often manifests with a broad array of symptoms and signs that might be similar to other diseases. The management of anaphylaxis consists of emergency treatment of acute episodes as well as preventive strategies to avoid recurrences. Treatment is complicated by its rapid onset and progression, presence of concurrent diseases or medications, and need for long-term allergen avoidance. Health care professionals must be able to recognize the signs of anaphylaxis, treat an episode promptly and appropriately, and provide preventive recommendations. Recognizing the gaps in our understanding and management of anaphylaxis may help identify promising targets for future treatment and prevention and areas that require further study.
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Affiliation(s)
- M Ben-Shoshan
- Division of Pediatric Allergy and Clinical Immunology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
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Chambel M, Martins P, Silva I, Palma-Carlos S, Romeira A, Leiria Pinto P. Drug provocation tests to betalactam antibiotics: experience in a paediatric setting. Allergol Immunopathol (Madr) 2010; 38:300-6. [PMID: 20478649 DOI: 10.1016/j.aller.2010.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Revised: 01/19/2010] [Accepted: 01/26/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases. METHODS We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed. RESULTS We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group. CONCLUSIONS DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.
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Genetic and ethnic risk factors associated with drug hypersensitivity. Curr Opin Allergy Clin Immunol 2010; 10:280-90. [DOI: 10.1097/aci.0b013e32833b1eb3] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fox S, Park MA. Penicillin skin testing in the evaluation and management of penicillin allergy. Ann Allergy Asthma Immunol 2010; 106:1-7. [PMID: 21195938 DOI: 10.1016/j.anai.2010.05.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 04/19/2010] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE to review the role of penicillin skin testing in the evaluation and management of penicillin allergy mediated by IgE. DATA SOURCES PubMed and OVID search of English-language articles regarding penicillin allergy, penicillin allergy testing, and management of penicillin allergy. STUDY SELECTION articles pertinent to the subject matter were selected and reviewed. RESULTS the major determinant (benzylpenicillin polylysine) detects the greatest number of penicillin allergic patients during skin testing, and the minor determinants of penicillin increase the sensitivity of penicillin skin testing. Penicillin skin testing to the major and minor determinants was found to have a negative predictive value of 97% to 99%. The incidence of systemic adverse reaction to penicillin skin testing is less than 1%. CONCLUSION a detailed history of the prior reaction to penicillin is an integral part of the evaluation, but it is not accurate in predicting a positive penicillin skin test result. A patient with a negative penicillin skin test result to the major and minor determinants is at a low risk of an immediate-type hypersensitivity reaction to penicillin. Patients with a positive skin test result should undergo desensitization to penicillin or an alternative antibiotic should be considered.
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Affiliation(s)
- Stephanie Fox
- Mayo Clinic College of Medicine and Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA
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Choi IS, Han ER, Lim SW, Lim SR, Kim JN, Park SY, Chae SK, Lim HH, Seol YA, Bae YI, Won YH. Beta-lactam antibiotic sensitization and its relationship to allergic diseases in tertiary hospital nurses. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2010; 2:114-22. [PMID: 20358025 PMCID: PMC2846734 DOI: 10.4168/aair.2010.2.2.114] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 01/13/2010] [Indexed: 12/02/2022]
Abstract
Purpose Skin allergies through type 1 and 4 hypersensitivity reactions are the most frequent manifestations of drug allergies. We had previously experienced a case of a nurse with cefotiam-induced contact urticaria syndrome. To aid in preventing the progression of drug-induced allergic disease in nurses, we conducted a survey of tertiary hospital nurses who were likely to have been exposed professionally to antibiotics. Methods All 539 staff nurses at a tertiary hospital were asked to respond to a questionnaire regarding antibiotic exposure. Of the 457 nurses (84.8%) who responded, 427 (79.2%) received a physical examination of the hands and 318 (59.0%) received skin prick tests with the β-lactam antibiotics cefotiam, cefoperazone, ceftizoxime, flomoxef, piperacillin and penicillin G. Results A positive response to at least one of the antibiotics occurred in 8 (2.6%) of the 311 subjects included in the analysis and stages 1 and 2 contact urticaria syndrome were observed in 38 (8.9%) and 3 (0.7%) of 427 nurses, respectively. The frequencies of a positive antibiotic skin test (6.9 versus 1.3%, χ2=7.15, P=0.018), stage 1 contact urticaria syndrome (14.4 versus 7.4%, χ2=4.33, P=0.038) and drug allergy (15.3 versus 3.6%, χ2=18.28, P=0.000) were higher in subjects with a positive skin allergy history than in those without. Allergic rhinitis (P=0.02, OR=3.86, CI=1.23-12.06), night cough (P=0.04, OR=3.12, CI=1.03-9.41) and food allergy (P=0.00, OR=9.90, CI=3.38-29.98) were significant risk factors for drug allergy. Conclusions Antibiotic sensitization and drug allergy occurred more frequently in nurses with a positive skin allergy history. Atopy may be an important risk factor for drug allergy.
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Affiliation(s)
- Inseon S Choi
- Allergy Division of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
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Renkonen J, Mattila P, Parviainen V, Joenväärä S, Toppila-Salmi S, Renkonen R. A network analysis of the single nucleotide polymorphisms in acute allergic diseases. Allergy 2010; 65:40-7. [PMID: 19796227 DOI: 10.1111/j.1398-9995.2009.02101.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Genetics of acute allergies has focused on identifying single nucleotide polymorphisms (SNPs) within genes relevant in the pathogenesis. In this study, we begin a systems biology analysis of the interconnectivity and biological functions of these genes, their transcripts and their corresponding proteins. METHODS The literature (Pubmed) was searched for SNPs within genes relevant in acute allergic diseases. The SNP-modified genes were converted to corresponding proteins and their protein-protein interactions were searched from six different databases. This interaction network was analysed with annotated vocabularies (ontologies), such as Gene Ontology, Reactome and Nature pathway interaction database. Time-series transcriptomics was performed with nasal epithelial cells obtained from allergic patients and their healthy control subjects. RESULTS A total of 39 genes with SNPs related to acute allergic diseases were found from a literature search. The corresponding proteins were then hooked into a large protein-protein interaction network with the help of various databases. Twenty-five SNP-related proteins had more than one interacting protein and a network contained 95 proteins, and 182 connections could be generated. This network was 10-fold enriched with protein kinases and proteins involved in the host-virus interaction compared with background human proteome. Finally, eight of the 95 nodes on our network displayed nasal epithelial transcriptomal regulation in a time-series analysis collected from birch allergic patients during the spring pollen season. CONCLUSIONS Signal transduction with special reference to host-virus interactions dominated in the allergy-related protein interaction network. Systems level analysis of allergy-related mutation can provide new insights into pathogenetic mechanisms of the diseases.
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Affiliation(s)
- J Renkonen
- Transplantation Laboratory & Infection Biology Research Program, Haartman Institute, University of Helsinki, Helsinki, Finland
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Current World Literature. Curr Opin Allergy Clin Immunol 2009; 9:386-90. [DOI: 10.1097/aci.0b013e32832eb836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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