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Erikstein BS, Alnæs MB, Apelseth TO. Blood transfusion-associated anaphylaxis in perioperative- and non-perioperative patients in Western Norway 2002-2021. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2024; 22:502-513. [PMID: 38814882 DOI: 10.2450/bloodtransfus.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/02/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Anaphylaxis after blood transfusion is a feared complication accounting for severe morbidity. A retrospective study was performed at Haukeland University Hospital, Bergen, Norway, to investigate the rate and features of transfusion-associated anaphylaxis (TAA) occurring between 2002-2021. MATERIALS AND METHODS Identified cases of TAA were studied by an immunologist and an allergist to extract information about general characteristics, amplifying factors, co-morbidity, treatment, and treatment responses. TAA was reported as perioperative or non-perioperative. RESULTS We identified 29 cases of TAA: 13 perioperative and 16 non-perioperative. Allergic transfusion reaction had an incidence rate of 34/100,000 transfusions and TAA a rate of 7/100,000 transfusions. The incidence of allergic reactions and TAA increased 2.6- and 6.4-fold during the study period. The first perioperative TAA was discovered 12 years into the study period but was equally frequent as non-perioperative transfusion-associated anaphylaxis in the last five years of the study period. 52% of the TAA cases had relevant co-morbidity and 100% of them had amplifying factors. Although only 38% of the non-perioperative patients received epinephrine as treatment, 94% of them had a good treatment response to their total treatment regimen. Poorer treatment response was observed with higher age, more cardiovascular- and respiratory disease, higher use of amplifying and sedating medications and a higher severity score. DISCUSSION Our findings indicate that TAA, especially in the perioperative setting, is underdiagnosed. The increased incidence of TAA in our study is temporally related to the introduction of a national hemovigilance program, introduction of standardized laboratory testing for anaphylaxis and increased multidisciplinary focus on the condition. In conclusion, increased awareness of TAA, and especially in the perioperative setting, is needed. A multidisciplinary approach is necessary to improve identification and reporting of TAA.
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Affiliation(s)
- Bjarte Skoe Erikstein
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
| | - Marie Bjørbak Alnæs
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Torunn Oveland Apelseth
- Department of Immunology and Transfusion Medicine, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
- Norwegian Armed Forces Joint Medical Services, Oslo, Norway
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Dagher J, Antonios D, Chollet-Martin S, de Chaisemartin L, Pallardy M, Azouri H, Irani C. Drug-induced hypersensitivity reactions in a Lebanese outpatient population: A decade-long retrospective analysis (2012-2021). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100169. [PMID: 37876854 PMCID: PMC10590748 DOI: 10.1016/j.jacig.2023.100169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 10/26/2023]
Abstract
Background Drug hypersensitivity reactions (DHRs) are becoming more common as a result of increasing prevalence and case complexity. Allergists and clinical immunologists worldwide are challenged daily to adequately diagnose and manage these reactions. Data in the literature regarding DHR outpatient consultations are scarce worldwide, limited in the Middle East, and currently unavailable in Lebanon. Objective This retrospective study aimed to evaluate the characteristics of all reported DHRs over 10 years in a tertiary-care allergy clinic in Lebanon. Methods We conducted a decade-long (2012-21) retrospective analysis of the archived medical records of patients with a history of DHRs. Demographics, clinical history, diagnostic tools, and characteristics of the DHRs were collected and analyzed. Results A total of 758 patients experienced DHRs to therapeutic molecules provided for ambulatory care. Our results identified 72 medications. The most frequently implicated drug classes included β-lactam antibiotics (53.8%), followed closely by nonsteroidal anti-inflammatory drugs (48.9%). Of the 758 patients, 32.6% reported DHRs to multiple molecules, and 11.8% reported concomitant DHRs to 1 or several molecules provided in the perioperative setting. Of those, opioids and neuromuscular blocking agents were the 2 most common therapeutic classes. Furthermore, we evaluated the cross-reactivity between molecules of the same class. In neuromuscular blocking agents, rocuronium and cisatracurium were the most commonly cross-reactive, and for opioids, the most common association we recorded was with morphine and pethidine. Conclusion Our findings constitute the first step toward a more comprehensive evaluation of the clinical characteristics of DHRs in Lebanon.
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Affiliation(s)
- Joelle Dagher
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Diane Antonios
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Sylvie Chollet-Martin
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Luc de Chaisemartin
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Marc Pallardy
- Université Paris-Saclay, INSERM, Inflammation Microbiome Immunosurveillance, Faculty of Pharmacy, Orsay, France
| | - Hayat Azouri
- Laboratory of Toxicology, Faculty of Pharmacy, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Carla Irani
- Internal Medicine and Clinical Immunology, University Medical Center Hôtel-Dieu de France Hospital, Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
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Qi Z, Cheng Y, Su Y, Qiao Y, Zhang J, Yang JJ, Xing Q. Clinical variables and genetic variants associated with perioperative anaphylaxis in Chinese Han population: A pilot study. World Allergy Organ J 2024; 17:100854. [PMID: 38223133 PMCID: PMC10784692 DOI: 10.1016/j.waojou.2023.100854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/20/2023] [Accepted: 12/07/2023] [Indexed: 01/16/2024] Open
Abstract
Background Perioperative anaphylaxis (POA) can lead to severe consequences. Identifying clinical risk factors and genetic loci associated with POA through pre-prescription screening may help reduce its incidence. Methods Using univariate regression and covariate-adjusted multivariate regression, we retrospectively analyzed the association between clinical characteristics and POA in 72 POA patients and 72 non-POA individuals. The discovery study of whole-exome association relied on whole-exome sequencing of 73 POA cases and 1339 healthy individuals. A replication study involving an independent set of 16 POA cases and 1339 healthy individuals confirmed this association. The accurate typing of human leucocyte antigen through exome sequencing (ATHLATES) algorithm and the whole-exome sequencing data were used for genotyping the human leucocyte antigen G (HLA-G) of 73 POA patients. The HLA-G of 16 POA cases and 122 non-POA patients were genotyped through Sanger sequencing. We used Fisher's exact probability method to compare the allele and carrier frequencies between POA patients and healthy individuals or non-POA patients. A Pc (P/Bonferroni correction coefficient) < 0.05 represents statistical significance. Results Regression analysis identified female sex, an unconfirmed food allergy label, and a history of prior surgery as clinical variables associated with POA. The whole-exome association discovery study identified a strong signal in the major histocompatibility complex region on chromosome 6, with the rs1130356 being the most significant locus (P = 1.5E-10, OR = 3.4, 95% CI = 2.4-4.9). The replication study verified the association between the rs1130356-T allele and POA cases (P = 1.0E-6, OR = 6.3, 95% CI = 3.1-12.7). Compared with non-POA patients, HLA-G∗01:01 (Pc = 2.4E-4, OR = 2.4, 95% CI = 1.6-3.6) was significantly enriched, while HLA-G∗01:04 (Pc = 1.2E-6, OR = 0.3, 95% CI = 0.2-0.5) was lessened in POA patients. Conclusion Our study suggested an association between POA and the risk factors of female sex, an unconfirmed food allergy label, and prior surgery. HLA-G, located in the human leucocyte antigen (HLA) region, may act as a surrogate genetic marker for POA. This suggests a causal relationship between this specific genomic region and POA. Our findings shed light on the contribution of human exome genetic variants to the susceptibility to POA.
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Affiliation(s)
- Zheng Qi
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
| | - Ye Cheng
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
| | - Yu Su
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
| | - Yimeng Qiao
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
| | - Jin Zhang
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
| | - Jian-jun Yang
- Department of Anaesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qinghe Xing
- Institutes of Biomedical Sciences of Fudan University and Children's Hospital of Fudan University, Shanghai, China
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Bansal V, Karim HMR, Rai AK, Bhuyan D, Kumar S. Perioperative Management Conundrum for a Case With Multiple Commonly Used Drug Hypersensitivity. Cureus 2024; 16:e53015. [PMID: 38410320 PMCID: PMC10895081 DOI: 10.7759/cureus.53015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024] Open
Abstract
Perioperative hypersensitivity reactions vary from mild to potentially fatal anaphylaxis, resulting in significant morbidity and mortality. Most of the perioperative hypersensitivity and allergic reactions are attributed to antibiotics, antiseptic solutions, latex, and opioids. In the current thrust for opioid-free anesthesia, owing to its multiple advantages, paracetamol and nonsteroidal antiinflammatory agents play a significant role in multi-modal pain and inflammatory response management. Nearly nine out of ten individuals experience postoperative pain, one-third experience postoperative nausea and vomiting, and one-fourth experience fever, irrespective of surgery and type of anesthesia, often as an inflammatory response. While perioperative hypersensitivity reactions are common, a patient allergic to multiple commonly used drugs for the treatment of pain, fever, acid-peptic disorder, and nausea and vomiting is scarce. Such cases pose a great challenge in perioperative management. A 14-year-old male child with a traumatic foot drop planned for tibialis posterior tendon transfer developed an allergic reaction with mild fever following an injection of Ranitidine and Ondansetron in the preoperative area. Surgery was deferred and was investigated for allergy profile testing for commonly used drugs, which showed high IgE levels and moderate to severe hypersensitivity for diclofenac and paracetamol. The patient was operated on after one month under spinal anesthesia, avoiding ranitidine, ondansetron, diclofenac, and paracetamol. The following morning, he developed a high-grade fever (102.3° F), which did not resolve with conservative measures. Hypersensitivity and allergic reactions to NSAIDs are reported in the literature. While there are multiple drugs available as NSAIDs, cross-sensitivity or allergy to other drugs within the same group, and even chemically related groups, is also another possibility that needs to be considered while managing such patients. Mefenamic acid controlled the fever, and the child was discharged home after 48 hours of observation. However, the case posed a great perioperative management dilemma; the present report intends to highlight and discuss it.
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Affiliation(s)
- Vikash Bansal
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Habib Md R Karim
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Abhishek K Rai
- Burn and Plastic Surgery, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Dipak Bhuyan
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
| | - Sanjay Kumar
- Anaesthesiology, Critical Care, and Pain Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, IND
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Villarreal-González RV, Canel-Paredes A, Arias-Cruz A, Fraga-Olvera A, Delgado-Bañuelos A, Rico-Solís GA, Ochoa-García IV, Jiménez-Sandoval JO, Ramírez-Heredia J, Flores-González JV, Cortés-Grimaldo RM, Zecua-Nájera Y, Ortega-Cisneros M. [Drug allergy: Fundamental aspects in diagnosis and treatment.]. REVISTA ALERGIA MÉXICO 2023; 69:195-213. [PMID: 37218047 DOI: 10.29262/ram.v69i4.1181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Any substance used as a treatment for any disease can produce harmful or unpleasant events called adverse drug reactions (ADRs). They are due to inherent biological effects of the drug and are caused by immunological and non-immunological mechanisms. OBJECTIVES To describe the immunological mechanisms of hypersensitivity reactions (HSR) to drugs, their epidemiology, risk factors, classification, clinical manifestations, diagnosis, treatment, and prognosis. METHODS A review of the most current literature in English and Spanish was carried out, in the main databases, related to the HSR of various drug groups. RESULTS This study describes the terms used to define ADRs and HSRs, their classification and clinical manifestations, current diagnostic tools, treatment algorithms and prognosis of the most frequently used medications and with the highest prevalence of reported adverse events. CONCLUSION ADRs are a challenging entity, with a complex pathophysiology that has not been fully understood. Its approach requires a careful consideration since not all drugs have validated tests for their diagnosis nor a specific treatment. When indicating the use of any drug, the severity of the disease, the availability of other treatments and the potential risks of developing future adverse events should always be taken into consideration.
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Affiliation(s)
- Rosalaura Virginia Villarreal-González
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alejandra Canel-Paredes
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alfredo Arias-Cruz
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alira Fraga-Olvera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Amerimed, Quintana Roo, México
| | - Angélica Delgado-Bañuelos
- Servicio de Alergia e Inmunología Clínica, Hospital General Regional 58, Instituto Mexicano del Seguro Social, Guanajuato, México
| | | | - Itzel Vianey Ochoa-García
- Departamento de Inmunología clínica y Alergia, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Jaime Omar Jiménez-Sandoval
- Departamento de Alergia e Inmunología Clínica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Regional Río Blanco, SESVER, Veracruz, México
| | - Jennifer Ramírez-Heredia
- Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital MAC, Irapuato, Guanajuato, México
| | | | - Rosa María Cortés-Grimaldo
- Departamento de Alergia e Inmunología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Yahvéh Zecua-Nájera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Centro Médico San Carlos, Tlaxcala, México
| | - Margarita Ortega-Cisneros
- Departamento de Inmunología Clínica y Alergia, Unidad Médica de Alta Especialidad, Hospital de especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social.
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