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Koumaki D, Gregoriou S, Evangelou G, Katoulis A, Papadakis M, Krueger-Krasagakis SE, Doxastaki A, Mylonakis D, Krasagakis K. Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions. Dermatol Ther (Heidelb) 2023; 13:3229-3239. [PMID: 38015412 PMCID: PMC10689598 DOI: 10.1007/s13555-023-01069-w] [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: 08/26/2023] [Accepted: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION The basophil activation test (BAT) is a flow cytometry laboratory technique that assesses the level of activation indicators expressed on the surface of basophils. We conducted a real-life study in a prospective cohort of patients with reported drug hypersensitivity reactions to determine the true relevance of BAT as a diagnostic tool for assessing immediate hypersensitivity reactions to medicines. METHODS We prospectively assessed individuals with clinical suspicion of immediate hypersensitivity reactions to drugs over a 2-year period. The allergological evaluation was carried out in accordance with European Academy of Allergy and Clinical Immunology (EAACI) guidance. All patients underwent BAT using the activation marker CD63. RESULTS In total 13 patients with 54 reported immediate drug hypersensitivity reactions to medications were included in this study. Twelve were female (92.3%) and one was male (7.70%). The mean ± SD age of the patients was 47.31 ± 19.94 years. Antibiotics were tested in 35.2% (19/54) of patients, corticosteroids in 24.1% (13/54), iodinated contrast medium in 14.8% (8/54), and NSAIDs in 5.6% (3/54). There was no correlation between the BAT results and the age of patients, gender, type of medication, or time interval between the allergic reaction and BAT procedure. The sensitivity of BAT 5% CD63+ basophils to drugs was 97.6%, specificity was 96% for drug allergies, positive predictive value (PPV) was 94.3%, and negative predictive value (NPV) was 95.2%. CONCLUSIONS The sensitivity of BAT for drug allergies is limited, but it can nevertheless be very helpful before contemplating provocation testing in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of medications for which no other tests are available or their results are ambiguous.
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Affiliation(s)
- Dimitra Koumaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece.
| | - Stamatios Gregoriou
- Department of Dermatology and Venereology, Medical School of Athens, Andreas Sygros Hospital, National and Kapodistrian University of Athens, I. Dragoumi 5, 161 21, Athens, Greece
| | - Georgios Evangelou
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Alexander Katoulis
- 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "Attikon" General University Hospital, Rimini 1, Haidari, 124 62, Athens, Greece
| | - Marios Papadakis
- Department of Surgery II, Witten/Herdecke University, Heusnerstrasse 40, 42283, Witten, Germany
| | | | - Aikaterini Doxastaki
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
| | - Dimitrios Mylonakis
- Dermatology Department, University Hospital of Heraklion, 71110, Heraklion, Crete, Greece
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Bahna SL, Assa'ad AH. Food Allergy: Catering for the Needs of the Clinician. Immunol Allergy Clin North Am 2021; 41:331-345. [PMID: 33863487 DOI: 10.1016/j.iac.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The practice of food allergy (FA) for clinicians has boomed, with a dramatic rise in the number of patients and families seeking care and with many advances on several fronts. The practice itself sometimes is evidence-based science and sometimes an art of pattern and phenotype recognition. This article examines the tools for diagnosis and management and therapy options available to physicians providing care for patients with FA. The article touches on pressing needs of clinicians and highlights the rapid and important movements in national and international support and advances that will have a positive impact on the field of FA.
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Affiliation(s)
- Sami L Bahna
- Allergy and Immunology Section, Louisiana State University Health Sciences Center in Shreveport, 1501 Kings Highway Rm 5-323 Shreveport, Louisiana 71130-3832, USA
| | - Amal H Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229.
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Abstract
The drug allergy "label" may have a lifetime of consequences for a child. Many children with alleged drug allergies are proven to be tolerant to the culprit medication when challenged. The field of drug hypersensitivity is a recently evolving field of research, but studies on its epidemiology and diagnostic tools are lacking in children. Clinical history is significant in the diagnosis and classification of drug hypersensitivity in children. Diagnostic tools have been evaluated in a limited number of children; therefore, the guidelines are mainly in line with those for adults. Here, we review the clinical characteristics, main drugs, risk factors, and diagnosis of drug hypersensitivity to aid in its accurate diagnosis in children.
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Affiliation(s)
- Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
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Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, Mahler V, Merk HF, Mülleneisen N, Ott H, Pfützner W, Röseler S, Ruëff F, Sitter H, Sunderkötter C, Trautmann A, Treudler R, Wedi B, Worm M, Brockow K. Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics: Guideline of the German Society for Allergology and Clinical Immunology (DGAKI) in collaboration with the German Society of Allergology (AeDA), German Society for Pediatric Allergology and Environmental Medicine (GPA), the German Contact Dermatitis Research Group (DKG), the Austrian Society for Allergology and Immunology (ÖGAI), and the Paul-Ehrlich Society for Chemotherapy (PEG). Allergol Select 2020; 4:11-43. [PMID: 32568254 PMCID: PMC7304290 DOI: 10.5414/alx02104e] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This guideline on diagnostic procedures for suspected beta-lactam antibiotic (BLA) hypersensitivity was written by the German and Austrian professional associations for allergology, and the Paul-Ehrlich Society for Chemotherapy in a consensus procedure according to the criteria of the German Association of Scientific Medical Societies. BLA such as penicillins and cephalosporins represent the drug group that most frequently triggers drug allergies. However, the frequency of reports of suspected allergy in patient histories clearly exceeds the number of confirmed cases. The large number of suspected BLA allergies has a significant impact on, e.g., the quality of treatment received by the individual patient and the costs to society as a whole. Allergies to BLA are based on different immunological mechanisms and often manifest as maculopapular exanthema, as well as anaphylaxis; and there are also a number of less frequent special clinical manifestations of drug allergic reactions. All BLA have a beta-lactam ring. BLA are categorized into different classes: penicillins, cephalosporins, carbapenems, monobactams, and beta-lactamase inhibitors with different chemical structures. Knowledge of possible cross-reactivity is of considerable clinical significance. Whereas allergy to the common beta-lactam ring occurs in only a small percentage of all BLA allergic patients, cross-reactivity due to side chain similarities, such as aminopenicillins and aminocephalosporins, and even methoxyimino cephalosporins, are more common. However, the overall picture is complex and its elucidation may require further research. Diagnostic procedures used in BLA allergy are usually made up of four components: patient history, laboratory diagnostics, skin testing (which is particularly important), and drug provocation testing. The diagnostic approach - even in cases where the need to administer a BLA is acute - is guided by patient history and risk - benefit ratio in the individual case. Here again, further studies are required to extend the present state of knowledge. Performing allergy testing for suspected BLA hypersensitivity is urgently recommended not only in the interests of providing the patient with good medical care, but also due to the immense impact of putative BLA allergies on society as a whole.
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Affiliation(s)
- Gerda Wurpts
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany
| | - Werner Aberer
- Department of Dermatology, Graz Medical University, Graz, Austria,
| | - Heinrich Dickel
- Department of Dermatology, Venereology and Allergology, St. Josef Hospital, University Hospital of the Ruhr University Bochum, Bochum,
| | - Randolf Brehler
- Department of Dermatology, University Hospital Münster, Münster,
| | - Thilo Jakob
- Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Gießen Site, Gießen,
| | - Burkhard Kreft
- Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale),
| | - Vera Mahler
- Paul-Ehrlich Institute, Langen,
- Department of Dermatology, University Hospital Erlangen, Erlangen,
| | - Hans F. Merk
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany
| | | | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Auf der Bult Children’s Hospital, Hannover,
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Gießen und Marburg, Marburg Site, Marburg,
| | - Stefani Röseler
- Clinic for Dermatology and Allergology, Aachen Comprehensive Allergy Center (ACAC), Uniklinik RWTH Aachen, Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich,
| | - Helmut Sitter
- Institute of Surgical Research, Philipps University Marburg, Marburg,
| | - Cord Sunderkötter
- Department of Dermatology and Venereology, University, Hospital Halle (Saale), Halle (Saale),
| | - Axel Trautmann
- Department of Dermatology and Allergy, Allergy Center Mainfranken, University Hospital Würzburg, Würzburg,
| | - Regina Treudler
- Department of Dermatology, Venereology, and Allergology and Leipzig Interdisciplinary Center for Allergology – LICA-CAC, University of Leipzig, Leipzig,
| | - Bettina Wedi
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Hannover Medical School, Hannover,
| | - Margitta Worm
- Department of Dermatology, Venereology, and Allergology, Charité University Hospital Berlin, Allergy Center Charité (ACC), Berlin, and
| | - Knut Brockow
- Department of Dermatology and Allergology am Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
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Wurpts G, Aberer W, Dickel H, Brehler R, Jakob T, Kreft B, Mahler V, Merk HF, Mülleneisen N, Ott H, Pfützner W, Röseler S, Ruëff F, Sitter H, Sunderkötter C, Trautmann A, Treudler R, Wedi B, Worm M, Brockow K. S2k-Leitlinie: Diagnostik bei Verdacht auf eine Betalaktamantibiotika-Überempfindlichkeit. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1876-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Guideline on diagnostic procedures for suspected hypersensitivity to beta-lactam antibiotics. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40629-019-0100-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dewachter P, Chollet-Martin S, Mouton-Faivre C, de Chaisemartin L, Nicaise-Roland P. Comparison of Basophil Activation Test and Skin Testing Performances in NMBA Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1681-1689. [DOI: 10.1016/j.jaip.2017.12.037] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/28/2017] [Accepted: 12/27/2017] [Indexed: 12/31/2022]
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Kidon M, Blanca-Lopez N, Gomes E, Terreehorst I, Tanno L, Ponvert C, Chin CW, Caubet JC, Soyer O, Mori F, Blanca M, Atanaskovic-Markovic M. EAACI/ENDA Position Paper: Diagnosis and management of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) in children and adolescents. Pediatr Allergy Immunol 2018; 29:469-480. [PMID: 29693290 DOI: 10.1111/pai.12915] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/02/2023]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in the pediatric population as antipyretics/analgesics and anti-inflammatory medications. Hypersensitivity (HS) reactions to NSAID in this age group, while similar to adults, have unique diagnostic and management issues. Although slowly accumulating, published data in this age group are still relatively rare and lacking a unifying consensus. This work is a summary of current knowledge and consensus recommendations utilizing both published data and expert opinion from the European Network of Drug Allergy (ENDA) and the Drug Hypersensitivity interest group in the European Academy of Allergy and Clinical Immunology (EAACI). This position paper summarizes diagnostic and management guidelines for children and adolescents with NSAIDs hypersensitivity.
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Affiliation(s)
- Mona Kidon
- The Pediatric Allergy Clinic, Sheba Medical Center, Tel Hashomer and the Sackler Faculty of Medicine, Safra Children's Hospital, Tel Aviv University, Tel Aviv, Israel
| | | | - Eva Gomes
- Allergy and Clinical Immunology Department, CHP, Porto, Portugal
| | - Ingrid Terreehorst
- Department of ENT and Pediatrics, Academisch Medisch Centrum, Amsterdam, The Netherlands
| | - Luciana Tanno
- Hospital Sírio Libanês, São Paulo, Brazil.,Division of Allergy, Department of Pulmonology, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France.,UPMC Paris 06, UMR-S 1136, IPLESP, Equipe EPAR, Sorbonne Universités, Paris, France
| | - Claude Ponvert
- Paediatric Pulmonology & Allergy Service, Assistance Publique-Hôpitaux de Paris, Hôpital Necker-Enfants Malades, Paris, France
| | - Chiang Wen Chin
- Department of Paediatrics, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore
| | | | - Ozge Soyer
- Pediatric Allergy Department, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Francesca Mori
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Children's University Hospital, Florence, Italy
| | - Miguel Blanca
- Allergy Service, Infanta Leonor University Hospital, Spain University, Madrid, Spain
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Jimenez-Rodriguez TW, Garcia-Neuer M, Alenazy LA, Castells M. Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers. J Asthma Allergy 2018; 11:121-142. [PMID: 29950872 PMCID: PMC6016596 DOI: 10.2147/jaa.s159411] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is the most serious of all allergic reactions and can be fatal. The diagnosis is frequently delayed, and misdiagnosis often occurs with asthma or urticaria. Biomarkers such as tryptase are not routinely checked, and appropriate treatment with epinephrine is not administered in a majority of cases, increasing the risk of poor outcomes. The objective of this review is to provide a better understanding of the pathophysiology of anaphylaxis with a description of phenotypes, endotypes, and biomarkers available in both the clinical and research settings. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among health care providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
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Affiliation(s)
- Teodorikez Wilfox Jimenez-Rodriguez
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Allergy Section, Alicante General University Hospital, Alicante, Spain
- PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Marlene Garcia-Neuer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leila A Alenazy
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Salas M, Fernández-Santamaría R, Mayorga C, Barrionuevo E, Ariza A, Posadas T, Laguna JJ, Montañez MI, Molina N, Fernández TD, Torres MJ. Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1010-1018.e2. [DOI: 10.1016/j.jaip.2017.08.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
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Thinnes A, Merk HF, Wurpts G, Röseler S, Lehmann S, Tenbrock K, Baron JM, Balakirski G. Individual risk assessment in the diagnosis of immediate type drug hypersensitivity reactions to betalactam and non-betalactam antibiotics using basophil activation test: a single center experience. Cutan Ocul Toxicol 2018; 37:309-318. [PMID: 29508626 DOI: 10.1080/15569527.2018.1448990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Drug hypersensitivity reactions of immediate type pose a challenging problem, especially, if standard diagnostic procedures do not lead to conclusive results. The aim of this investigation is to identify, whether basophil activation test (BAT) is able to provide additional benefit in the diagnostic evaluation of immediate type drug hypersensitivity reactions to antibiotics in comparison with the routine allergological diagnostic methods. MATERIALS AND METHODS We investigated patients, who presented to the Department of Dermatology and Allergology of the University Hospital of RWTH Aachen in Germany for diagnostic workup of type I allergic reactions to antibiotics during the period from 2009 to 2012. The analysis was performed retrospectively based on patient records. The inclusion criteria were performed standard allergological in vivo diagnostic and a BAT as a part of diagnostic workup. RESULTS Eighty-two diagnostic investigations were performed in 52 patients. BAT was positive in 9 of 12 cases with a positive clinical history but negative skin test results. Furthermore, all patients who reported severe drug hypersensitivity reactions (anaphylactic reaction grade 2 and above) showed positive BAT (5/5), while only three of these five cases demonstrated a positive skin testing that led to the conclusion of possible immediate type drug hypersensitivity. CONCLUSIONS Although skin tests remain the most important part of the primary diagnostic investigation, BAT is an additional valuable and sensitive in vitro test in the diagnostic procedure of immediate type allergic reactions to antibiotics. However, further standardized investigations are needed in order to calculate exact sensitivity and specificity of this diagnostic tool in both, adult and pediatric populations.
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Affiliation(s)
- Antonia Thinnes
- a Department of Ophthalmology , University Hospital of RWTH Aachen , Aachen , Germany
| | - Hans F Merk
- b Department of Dermatology and Allergology , University Hospital of RWTH Aachen , Aachen , Germany
| | - Gerda Wurpts
- b Department of Dermatology and Allergology , University Hospital of RWTH Aachen , Aachen , Germany
| | - Stefani Röseler
- b Department of Dermatology and Allergology , University Hospital of RWTH Aachen , Aachen , Germany
| | - Sylvia Lehmann
- c Department of Pediatrics and Adolescent Medicine , University Hospital of RWTH Aachen , Aachen , Germany
| | - Klaus Tenbrock
- c Department of Pediatrics and Adolescent Medicine , University Hospital of RWTH Aachen , Aachen , Germany
| | - Jens Malte Baron
- b Department of Dermatology and Allergology , University Hospital of RWTH Aachen , Aachen , Germany
| | - Galina Balakirski
- b Department of Dermatology and Allergology , University Hospital of RWTH Aachen , Aachen , Germany
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Component-Resolved and Complementary Tests in the Diagnosis of Occupational Allergy: Advantages and Limitations. CURRENT TREATMENT OPTIONS IN ALLERGY 2017. [DOI: 10.1007/s40521-017-0124-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Lavergne SN. In Vitro Research Tools in the Field of Human Immediate Drug Hypersensitivity and Their Present Use in Small Animal Veterinary Medicine. Vet Sci 2016; 4:E1. [PMID: 29056660 PMCID: PMC5606612 DOI: 10.3390/vetsci4010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/23/2016] [Accepted: 12/13/2016] [Indexed: 12/18/2022] Open
Abstract
Drug hypersensitivity reactions (DHR) are immune-mediated idiosyncratic adverse drug events. Type I DHR are often referred to as "immediate" and involve B lymphocyte-secreted IgE that bind to the membrane of basophils and mast cells, inducing their degranulation. This review presents various in vitro tests that were developed in the field of human type I HS and implemented as clinical diagnostic tools in human cases of immediate DHR. The respective strengths and weaknesses of each test will be discussed in parallel of validation data such as specificity and sensitivity whenever available. Some of them have also been used as diagnostic tools in veterinary medicine, but not in cases of immediate DHR. Most of these diagnostic tools can be categorized into humoral and cellular tests. The former tests measure serum concentrations of factors, such as histamine, tryptase, and drug-specific IgE. The latter assays quantify markers of drug-induced basophil activation or drug-specific lymphocyte proliferation. Pharmacogenetic markers have also been investigated in immediate DHR, but not as extensively as in non-immediate ones. Throughout, practical aspects and limitations of the tests, as well as sensitivity and specificity parameters, will be presented. In addition, the experience of veterinary medicine with these diagnostic tools will be summarized. However, to date, none of them has ever been reported in a veterinary case of type I DHR.
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Affiliation(s)
- Sidonie N. Lavergne
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois-Urbana-Champaign, 2001 South Lincoln Av, Urbana, IL 61802, USA.
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Williams AN. Diagnostic Evaluation in Aspirin-Exacerbated Respiratory Disease. Immunol Allergy Clin North Am 2016; 36:657-668. [PMID: 27712761 DOI: 10.1016/j.iac.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Aspirin-exacerbated respiratory disease (AERD) is a distinct clinical condition characterized by chronic sinusitis with nasal polyps, asthma, and hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs). Distinguishing AERD from other forms of chronic sinusitis, asthma, and NSAID reactivity has important clinical implications for management. The clinical history is helpful, but not adequate for confirming the diagnosis of AERD, in most cases. Diagnostic provocation challenge remains the only way to confirm or exclude the diagnosis of AERD. This article discusses the utility of the clinical history and the current evidence regarding measures that optimize the safety of performing diagnostic NSAID provocation challenges.
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Affiliation(s)
- Adam N Williams
- Department of Allergy, Asthma, and Immunology, Bend Memorial Clinic, 815 Southwest Bond Street, Bend, OR 97702, USA; School of Medicine, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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Atanaskovic-Markovic M, Caubet JC. Management of drug hypersensitivity in the pediatric population. Expert Rev Clin Pharmacol 2016; 9:1341-1349. [DOI: 10.1080/17512433.2016.1213131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Demir S, Olgac M, Unal D, Gelincik A, Colakoglu B, Buyukozturk S. Evaluation of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs according to the latest classification. Allergy 2015; 70:1461-7. [PMID: 26173603 DOI: 10.1111/all.12689] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM The consensus document for hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) proposed by the European Network for Drug Allergy (ENDA) interest group (2011) was revised in 2013. We aimed to evaluate the usability of the latest NSAID hypersensitivity classification of ENDA. METHOD A total of 370 patients with a history of hypersensitivity reactions to NSAIDs among the 1250 outpatients referred for suspected drug allergy between July 2013 and June 2014 were evaluated, and 308 patients who were confirmed as having NSAID hypersensitivity were included in this study. After confirming the diagnosis, a single-blind placebo-controlled drug provocation test was performed with aspirin or diclofenac to categorize the patients according to the ENDA classification. The reactions not meeting the ENDA classification criteria were grouped as blended reactions. RESULTS Among the 308 patients (224 female, mean age 42.12 ± 13.24), the leading cause of hypersensitivity reactions was metamizol (30.5%) followed by aspirin (30.2%). The most common NSAID hypersensitivity subgroup was SNIUAA (46.4%) and the least common type was SNIDR (1.6%). Cross-reactivity was identified in 50.3% of the patients. In five patients (1.6%), the hypersensitivity reactions to NSAIDs did not meet the ENDA classification: Three patients experienced anaphylaxis with different NSAIDs, one patient encountered anaphylaxis with one NSAID and urticaria with other NSAIDs, and the last patient had angioedema with different NSAIDs. CONCLUSION The latest ENDA classification for NSAID hypersensitivity is generally a practical and useful instrument for clinicians. We only point out that anaphylaxis with different NSAIDs can be seen in a small group of patients.
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Affiliation(s)
- S. Demir
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - M. Olgac
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - D. Unal
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - A. Gelincik
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - B. Colakoglu
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
| | - S. Buyukozturk
- Division of Immunology and Allergic Diseases; Department of Internal Medicine; Istanbul Faculty of Medicine; Istanbul University; Istanbul Turkey
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Stone SF, Phillips EJ, Wiese MD, Heddle RJ, Brown SGA. Immediate-type hypersensitivity drug reactions. Br J Clin Pharmacol 2015; 78:1-13. [PMID: 24286446 DOI: 10.1111/bcp.12297] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/18/2013] [Indexed: 11/27/2022] Open
Abstract
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive.
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Affiliation(s)
- Shelley F Stone
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research and the University of Western Australia, Perth, Western Australia; Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia
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21
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Elzagallaai AA, Rieder MJ. In vitro testing for diagnosis of idiosyncratic adverse drug reactions: Implications for pathophysiology. Br J Clin Pharmacol 2015; 80:889-900. [PMID: 25199801 DOI: 10.1111/bcp.12505] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/31/2014] [Indexed: 12/19/2022] Open
Abstract
Idiosyncratic drug reactions (IDRs) represent a major health problem, as they are unpredictable, often severe and can be life threatening. The low incidence of IDRs makes their detection during drug development stages very difficult causing many post-marketing drug withdrawals and black box warnings. The fact that IDRs are always not predictable based on the drug's known pharmacology and have no clear dose-effect relationship with the culprit drug renders diagnosis of IDRs very challenging, if not impossible, without the aid of a reliable diagnostic test. The drug provocation test (DPT) is considered the gold standard for diagnosis of IDRs but it is not always safe to perform on patients. In vitro tests have the advantage of bearing no potential harm to patients. However, available in vitro tests are not commonly used clinically because of lack of validation and their complex and expensive procedures. This review discusses the current role of in vitro diagnostic testing for diagnosis of IDRs and gives a brief account of their technical and mechanistic aspects. Advantages, disadvantages and major challenges that prevent these tests from becoming mainstream diagnostic tools are also discussed here.
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Affiliation(s)
- Abdelbaset A Elzagallaai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Michael J Rieder
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,CIHR-GSK Chair in Pediatric Clinical Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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22
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Caubet JC, Frossard C, Fellay B, Eigenmann PA. Skin tests and in vitro allergy tests have a poor diagnostic value for benign skin rashes due to β-lactams in children. Pediatr Allergy Immunol 2015; 26:80-2. [PMID: 25469811 DOI: 10.1111/pai.12314] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jean-Christoph Caubet
- Department of Child and Adolescent, University Hospitals of Geneva and Medical School of The University of Geneva, Geneva, Switzerland.
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23
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Kim MH, Lee JM. Diagnosis and management of immediate hypersensitivity reactions to cephalosporins. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 6:485-95. [PMID: 25374747 PMCID: PMC4214968 DOI: 10.4168/aair.2014.6.6.485] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/03/2014] [Indexed: 12/16/2022]
Abstract
Cephalosporins can cause a range of hypersensitivity reactions, including IgE-mediated, immediate reactions. Cephalosporin allergy has been reported with use of a specific cephalosporin, as a cross-reaction between different cephalosporins or as a cross-reaction to other β-lactam antibiotics. Unlike penicillins, the exact allergenic determinants of cephalosporins are less well understood and thus, standardized diagnostic skin testing is not available. Nevertheless, skin testing with diluted solutions of cephalosporins can be valuable in confirming IgE-mediated hypersensitivity reactions. In vitro tests are in development using recent technological advances and can be used as complementary tests. However, they are not commonly used because of their reduced sensitivity and limited availability. In selected cases of inconclusive results in both skin tests and IgE assays, a graded challenge or induction of drug tolerance with the implicated cephalosporin should be performed.
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Affiliation(s)
- Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jong-Myung Lee
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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24
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Nam YH, Hwang EK, Ban GY, Jin HJ, Yoo HS, Shin YS, Ye YM, Nahm DH, Park HS, Lee SK. Immunologic evaluation of patients with cefotetan-induced anaphylaxis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:301-3. [PMID: 25749763 PMCID: PMC4397372 DOI: 10.4168/aair.2015.7.3.301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/27/2013] [Accepted: 02/20/2014] [Indexed: 12/12/2022]
Abstract
Cefotetan is a commonly prescribed second-generation cephalosporin that acts against a wide range of bacteria. However, cefotetan-induced hypersensitivity has rarely been reported. We report 2 cases of cefotetan-induced anaphylaxis with immunologic evaluation. The first case was a 70-year-old asthmatic woman who had dyspnea and hypotension during administration of cefotetan, in which high serum-specific IgE to cefotetan-human serum albumin (HSA) conjugate was detected by enzyme-linked immunosorbent assay. The second case was a 63-year-old asthmatic woman who complained of chest tightness and dyspnea during cefotetan infusion, in which high serum-specific IgG1 and IgG4 with no serum specific IgE to cefotetan-HSA conjugate was detected. The basophil activation test using basophils from the patient showed a significant up-regulation of CD63 with the addition of anti-IgG4 antibody compared with that in non-atopic healthy controls. In conclusion, cefotetan can induce anaphylaxis, which may involve both IgE- and IgG4-mediated responses in the pathogenic mechanism.
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Affiliation(s)
- Young Hee Nam
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea
| | - Eui Kyung Hwang
- Department of Allergy & Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ga Young Ban
- 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
| | - Hye Soo Yoo
- 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
| | - Dong Ho Nahm
- 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
| | - Soo Keol Lee
- Department of Internal Medicine, College of Medicine, Dong-A University, Busan, Korea.
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25
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Möbs C, Pfützner W. Cellular in vitro diagnosis of adverse drug reactions. ACTA ACUST UNITED AC 2014; 23:164-171. [PMID: 26120528 PMCID: PMC4479488 DOI: 10.1007/s40629-014-0020-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 05/08/2014] [Indexed: 12/11/2022]
Abstract
Adverse drug reactions can manifest clinically in a variety of ways. Whilst the majority can be explained by dose-dependent side effects, there is group of unpredictable immunological or non-immunological intolerances that represent a particular diagnostic challenge. Skin tests are frequently negative, whilst challenge tests are time-consuming and often hazardous. Against this backdrop, cellular in vitro tests play a particularly important role in the identification of the causative drug. Whilst basophil tests can be used in the case of immunoglobulin E (IgE)- as well as non-IgE-mediated hypersensitivity reactions, T-cellular test methods assist in the diagnosis of drug eruptions. The reliability of individual tests can be affected by a variety of parameters, such as the pathomechanism underlying the drug reaction, the causative medication, or the point in time of testing. Not only is a sound knowledge of the basic principles of the individual assays an essential prerequisite for correctly indicating and interpreting this test method, but also an awareness of these additional factors.
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Affiliation(s)
- Christian Möbs
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, Allergy Center Hessen, Philipps University Marburg, Marburg, Germany ; Clinical & Experimental Allergy, Allergy Center Hessen, Department of Dermatology and Allergology, Philipps-University Marburg, Baldingerstraße, 35043 Marburg, Germany
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26
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Zelluläre In-vitro-Diagnostik von Arzneimittelreaktionen. ALLERGO JOURNAL 2014. [DOI: 10.1007/s15007-014-0617-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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Local and General Anesthetics Immediate Hypersensitivity Reactions. Immunol Allergy Clin North Am 2014; 34:525-46, viii. [DOI: 10.1016/j.iac.2014.03.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Leysen J, Sabato V, Verweij MM, De Knop KJ, Bridts CH, De Clerck LS, Ebo DG. The basophil activation test in the diagnosis of immediate drug hypersensitivity. Expert Rev Clin Immunol 2014; 7:349-55. [DOI: 10.1586/eci.11.14] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Torres MJ, Mayorga C, Blanca-López N, Blanca M. Hypersensitivity reactions to beta-lactams. EXPERIENTIA SUPPLEMENTUM (2012) 2014; 104:165-84. [PMID: 24214624 DOI: 10.1007/978-3-0348-0726-5_11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Beta-lactam antibiotics (BLs) are the most frequent cause of hypersensitivity reactions mediated by specific immunological mechanisms, with two main types, IgE reactions or T-cell-dependent responses. From a practical point of view, these reactions can be classified into immediate, for those appearing within 1 h after drug intake, and non-immediate, for those appearing at least 1 h after and usually within 24 h of BL administration. The clinical symptoms differ according to this classification. Urticaria and anaphylaxis are the most frequently recorded symptoms in immediate reactions and maculopapular exanthema and delayed urticaria in non-immediate reactions. Although the exact diagnostic approach differs depending on the underlying mechanism, it is based on the performance of skin testing, laboratory tests, and drug provocation tests.T cells are a key factor in all types of hypersensitivity reactions to BLs, regulating both IgE production or acting as effector cells, with a different profile of cytokine production. A Th1 pattern is observed in both CD4(+) and CD8(+) peripheral T cells in non-immediate reactions, whereas a Th2 pattern is expressed in CD4(+) T cells in immediate reactions.
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Affiliation(s)
- Maria J Torres
- Allergy Service, pabellón 6, primera planta, IBIMA, Carlos Haya Hospital (Pabellon C), Plaza del Hospital Civil, 29009, Malaga, Spain,
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30
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Blanca-Lopez N, J Torres M, Doña I, Campo P, Rondón C, Seoane Reula ME, Salas M, Canto G, Blanca M. Value of the clinical history in the diagnosis of urticaria/angioedema induced by NSAIDs with cross-intolerance. Clin Exp Allergy 2013; 43:85-91. [PMID: 23278883 DOI: 10.1111/cea.12013] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/15/2012] [Accepted: 08/13/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Multiple Non-steroidal anti-inflammatory drugs (NSAID)-induced urticaria/angioedema is the most common manifestation of hypersensitivity reactions to NSAIDs. Diagnostic evaluation is based on the clinical history and a drug provocation test. OBJECTIVE To evaluate the role of the clinical history in the diagnosis of multiple NSAID-induced urticaria/angioedema. METHODS We studied a group of patients with an unequivocal history of urticaria and/or angioedema after NSAID intake. Subjects had to have had at least two episodes of cutaneous symptoms with two different COX-1 inhibitors. The diagnosis was confirmed in all cases by a drug provocation test with acetyl salicylic acid (ASA). Multivariate analysis was done by analysing different variables, including number of drugs involved, episodes and time elapsed between drug intake and symptom onset. RESULTS Of the total group of 75 cases with multiple NSAID-induced urticaria/angioedema diagnosed according to the clinical history, 76% developed a positive drug provocation test with ASA. The risk for having hypersensitivity was 17 times higher in patients who developed symptoms within the first 60 min after drug intake, 13 times higher in those who experienced reactions with more than two non-chemically related NSAIDs, and 10 times higher in women. CONCLUSIONS Drug provocation testing with ASA confirms the diagnosis of multiple NSAID-induced urticaria/angioedema in up to 92% of cases with an unequivocal clinical history, when reactions occur within 1 h and more than two different NSAIDs are involved.
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Affiliation(s)
- N Blanca-Lopez
- Allergy Service, Infanta Leonor Hospital, Madrid, Spain.
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31
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Abstract
Children with multiple drug allergies are likely to require treatment with one or more of the drugs to which they may have had a reaction, when there is no alternate effective drug available. Detailed review of their history and/or use of appropriate diagnostic studies will help determine the potential safety of readministering the desired drug as well as the method for its readministration, most likely in the form of a drug challenge or desensitization. A practical approach to the diagnosis and treatment of children with multiple drug allergies is described in this review.
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Affiliation(s)
- Anahita Falakshahi Dioun
- Children's Hospital Boston, Division of Immunology, Harvard Medical School, Boston, MA 02115, USA.
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33
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Mertes PM, Demoly P, Malinovsky JM. Complications anaphylactiques et anaphylactoïdes de l’anesthésie générale. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0289(12)59003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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34
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35
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Gómez E, Torres MJ, Mayorga C, Blanca M. Immunologic evaluation of drug allergy. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:251-63. [PMID: 22950030 PMCID: PMC3423598 DOI: 10.4168/aair.2012.4.5.251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/01/2012] [Indexed: 12/21/2022]
Abstract
Hypersensitivity drug reactions (HDR) consist of an individual abnormal response with the involvement of the immunological system. In addition to specific immunological mechanisms where specific antibodies or sensitised T cells participate, release of inflammatory mediators by non-specific immunological recognition may also occur. Within this category are one of the most common groups of drugs, the non-steroidal anti-inflammatory drugs. In addition to chemical drugs new emerging ones with an increasing protagonism are biological agents like humanised antibodies and others. For IgE dependent reactions both in vivo and in vitro tests can be used for the immunological evaluation. Sensitivity of these is not optimal and very often a drug provocation test must be considered for knowing the mechanism involved and/or establishing the diagnosis. For non-immediate reactions also both in vivo and in vitro tests can be used. Sensitivity for in vivo tests is generally low and in vitro tests may be needed for the immunological evaluation. Immunohistochemical studies of the affected tissue enable a more precise classification of non-immediate reactions. The monitorization of the acute response of the reactions has given clues for understanding these reactions and has promising results for the future of the immunological evaluation of HDR.
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Affiliation(s)
- Enrique Gómez
- Research Laboratory, Carlos Haya Hospital, Málaga, Spain
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36
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Chirumbolo S. Basophil Activation Test in Allergy: Time for an Update? Int Arch Allergy Immunol 2012; 158:99-114. [DOI: 10.1159/000331312] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 07/29/2011] [Indexed: 11/19/2022] Open
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37
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Chirumbolo S. Monitoring of CD63% in basophil activation test and suggested new parameters for allergy diagnosis. Inflamm Res 2011; 61:171-6. [PMID: 22205176 DOI: 10.1007/s00011-011-0416-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 10/27/2011] [Accepted: 12/06/2011] [Indexed: 12/26/2022] Open
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Caimmi S, Caimmi D, Lombardi E, Crisafulli G, Franceschini F, Ricci G, Marseglia G. Antibiotic Allergy. Int J Immunopathol Pharmacol 2011; 24:S47-53. [DOI: 10.1177/03946320110240s307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Antibiotics are commonly injected during the perioperative period and are responsible of 15% of the anaphylactic reactions. Anaphylaxis triggered by antibiotics primarily involves penicillin and cephalosporin. The management of patients with histories of allergic reactions to antibiotics is a common situation in clinical practice. The confirmation or invalidation of the allergic nature of the reported reaction is not based on in vitro tests, but on a rigorous allergological work-up based on detailed analysis of clinical history, skin tests and drug provocation test. Considering a possible cross-reactivity between penicillins, once an immediate penicillin allergy has been diagnosed, skin testing with the alternative molecule (cephalosporin, carbapenem, aztreonam) is mandatory and, if negative, the relevant drug should be given in an appropriate setting at increasing doses.
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Affiliation(s)
- S. Caimmi
- Pediatric Unit, “Maggiore” Hospital, Crema, Department of Pediatrics, University of Pavia, Italy
| | - D. Caimmi
- Department of Pediatrics, “San Matteo” Foundation IRCCS, University of Pavia, Pavia, Italy
| | - E. Lombardi
- Unit of Respiratory Medicine, Department of Pediatrics, University of Florence, Anna Meyer University Hospital for Children, Florence, Italy
| | - G. Crisafulli
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - F. Franceschini
- Pediatric Unit, “Ospedali Riuniti”, University Hospital, Ancona, Italy
| | - G. Ricci
- Department of Pediatrics, University of Bologna, Bologna, Italy
| | - G.L. Marseglia
- Department of Pediatrics, “San Matteo” Foundation IRCCS, University of Pavia, Pavia, Italy
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39
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Kowalski ML, Makowska JS, Blanca M, Bavbek S, Bochenek G, Bousquet J, Bousquet P, Celik G, Demoly P, Gomes ER, Niżankowska-Mogilnicka E, Romano A, Sanchez-Borges M, Sanz M, Torres MJ, De Weck A, Szczeklik A, Brockow K. Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, diagnosis and management: review of the EAACI/ENDA(#) and GA2LEN/HANNA*. Allergy 2011; 66:818-29. [PMID: 21631520 DOI: 10.1111/j.1398-9995.2011.02557.x] [Citation(s) in RCA: 265] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are responsible for 21-25% of reported adverse drug events which include immunological and nonimmunological hypersensitivity reactions. This study presents up-to-date information on pathomechanisms, clinical spectrum, diagnostic tools and management of hypersensitivity reactions to NSAIDs. Clinically, NSAID hypersensitivity is particularly manifested by bronchial asthma, rhinosinusitis, anaphylaxis or urticaria and variety of late cutaneous and organ-specific reactions. Diagnosis of hypersensitivity to a NSAID includes understanding of the underlying mechanism and is necessary for prevention and management. A stepwise approach to the diagnosis of hypersensitivity to NSAIDs is proposed, including clinical history, in vitro testing and/or provocation test with a culprit or alternative drug depending on the type of the reaction. The diagnostic process should result in providing the patient with written information both on forbidden and on alternative drugs.
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Affiliation(s)
- Marek L Kowalski
- Department of Immunology, Rheumatology and Allergy, Medical University of Lodz, Poland.
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40
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Abstract
Peri-operative anaphylaxis is an important cause for mortality and morbidity associated with anaesthesia. The true incidence is unknown and is most likely under reported. Diagnosis can be difficult, particularly as a number of drugs are given simultaneously and any of these agents can potentially cause anaphylaxis. This review covers the clinical features, differential diagnosis and management of anaphylaxis associated with anaesthesia. The investigations to confirm the clinical suspicion of anaphylaxis and further tests to identify the likely drug(s) are examined. Finally the salient features of common and rare causes including non-drug substances are described.
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Affiliation(s)
- Linda Nel
- Department of Anaesthetics, Southampton University Hospitals NHS TrustTremona Road, Southampton, United Kingdom
| | - Efrem Eren
- Department of Immunology, Southampton University Hospitals NHS TrustTremona Road, Southampton, United Kingdom
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41
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Diagnosis and management of drug hypersensitivity reactions. J Allergy Clin Immunol 2011; 127:S67-73. [PMID: 21354502 DOI: 10.1016/j.jaci.2010.11.047] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Accepted: 11/12/2010] [Indexed: 11/24/2022]
Abstract
The present article addresses the advances in the diagnosis and management of drug hypersensitivity reactions that were discussed in the 4th Drug Hypersensitivity Meeting held in Rome in April 2010. Such reactions can be classified as immediate or nonimmediate according to the time interval between the last drug administration and onset. Immediate reactions occur within 1 hour, and nonimmediate reactions occur after more than 1 hour. Clinical and immunologic studies suggest that type-I (IgE-mediated) and type-IV (T cell-mediated) pathogenic mechanisms are involved in most immediate and nonimmediate reactions, respectively. In diagnosis prick, patch, and intradermal tests are the most readily available tools. Determination of specific IgE levels is still the most common in vitro method for diagnosing immediate reactions. New diagnostic tools, such as the basophil activation test, the lymphocyte activation test, and enzyme-linked immunospot assays for analysis of the frequency of antigen-specific, cytokine-producing cells, have been developed for evaluating either immediate or nonimmediate reactions. The sensitivity of allergologic tests is not 100%; therefore in selected cases provocation tests are necessary. In the diagnosis of nonallergic hypersensitivity reactions to nonsteroidal anti-inflammatory drugs, the provocation test with the suspected drug still represents the "gold standard." However, there was no consensus regarding the use of this test in subjects with histories of hypersensitivity reactions to 1 (single reactors) or more (multiple reactors) nonsteroidal anti-inflammatory drugs. With regard to management, desensitization allows patients to be treated with irreplaceable chemotherapy agents, such as taxanes, platinum salts, and mAbs, to which they have presented hypersensitivity reactions. Desensitization also permits the use of aspirin in aspirin-sensitive patients undergoing revascularization and in subjects with aspirin-exacerbated respiratory disease.
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42
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McLean-Tooke A, Aldridge C, Stroud C, Spickett GP. Practical management of antibiotic allergy in adults. J Clin Pathol 2010; 64:192-9. [PMID: 21177267 DOI: 10.1136/jcp.2010.077289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
This review looks at the main issues around immediate hypersensitivity and the role and limitations of testing. The majority of literature on antibiotic hypersensitivity relates to β-lactam antibiotics, mainly because of the heavy usage of this class of drugs. Concerns around cross-reactivity always worry clinicians, particularly in the emergency situation. Reasonable data now exist in relation to β-lactam antibiotics and derivatives, which enable appropriate risk management to be undertaken. The available literature for other classes of antibiotics is also discussed.
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Affiliation(s)
- Andrew McLean-Tooke
- Department of Immunology, Fremantle Hospital and PathWest Laboratory Medicine, Fremantle, Perth, Australia.
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43
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Ponvert C, Scheinmann P, de Blic J. Anaphylaxis to the 23-valent pneumococcal vaccine: A second explored case by means of immediate-reading skin tests with pneumococcal vaccines. Vaccine 2010; 28:8256-7. [DOI: 10.1016/j.vaccine.2010.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 09/28/2010] [Accepted: 10/12/2010] [Indexed: 11/25/2022]
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45
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García-Ortega P, Marín A. Usefulness of the basophil activation test (BAT) in the diagnosis of life-threatening drug anaphylaxis. Allergy 2010; 65:1204. [PMID: 20148801 DOI: 10.1111/j.1398-9995.2010.02333.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- P García-Ortega
- Allergy Unit and Immunology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
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46
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Current World Literature. Curr Opin Allergy Clin Immunol 2010; 10:400-6. [DOI: 10.1097/aci.0b013e32833d232e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mertes PM, Tajima K, Regnier-Kimmoun MA, Lambert M, Iohom G, Guéant-Rodriguez RM, Malinovsky JM. Perioperative anaphylaxis. Med Clin North Am 2010; 94:761-89, xi. [PMID: 20609862 DOI: 10.1016/j.mcna.2010.04.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The incidence of immune-mediated anaphylaxis during anesthesia ranges from 1 in 10,000 to 1 in 20,000. Neuromuscular blocking agents are most frequently incriminated, followed by latex and antibiotics, although any drug or substance used may be a culprit. Diagnosis relies on tryptase measurements at the time of the reaction and skin tests, specific immunoglobulin E, or basophil activation assays. Treatment consists of rapid volume expansion and epinephrine administration titrated to symptom severity.
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Affiliation(s)
- P M Mertes
- Service d'Anesthésie-Réanimation Chirurgicale, CHU de Nancy, Hôpital Central, 29 Avenue de Lattre de Tassigny, 54035 Nancy Cedex, France.
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:191-4. [DOI: 10.1097/moo.0b013e32833ad4c9] [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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Nosbaum A, Rozières A, Ben Said B, Nicolas JF, Bérard F. Toxidermies aux glycopeptides. Ann Dermatol Venereol 2010; 137:341-2. [DOI: 10.1016/j.annder.2010.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2010. [DOI: 10.1002/pds.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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