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van Cuilenborg VR, Hermanides J, Bos EME, Hollmann MW, Preckel B, Kooij FO, Terreehorst I. Perioperative approach of allergic patients. Best Pract Res Clin Anaesthesiol 2020; 35:11-25. [PMID: 33742571 DOI: 10.1016/j.bpa.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 12/18/2022]
Abstract
Perioperative allergic reactions are rare, yet important complications of anesthesia. Severe, generalized allergic reactions called anaphylaxis are estimated to have a mortality of 3.5-4.8%. Adequate recognition and handling of a severe perioperative anaphylactic reaction result in better outcomes, including less hypoxic-ischemic encephalopathy and death. The diagnosis of a perioperative allergic reaction can be difficult as the list of possible culprits of a perioperative allergic reaction is extensive. Making an informed guess on the causative agent and avoiding this agent in future anesthesia procedures is undesirable and unsafe. Therefore, to ensure future patient safety, a thorough investigation following a perioperative allergic reaction is mandatory. A collaborate approach by allergists and anesthesiologists is advised. In this article, we discuss the basic approach of the allergic patient and of patients with a suspected allergy to perioperatively administered medication.
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Affiliation(s)
- Vincent R van Cuilenborg
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Jeroen Hermanides
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Elke M E Bos
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Benedikt Preckel
- Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Fabian O Kooij
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - Ingrid Terreehorst
- Dutch Perioperative Allergy Centre, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Otorhinolaryngology, Amsterdam University Medical Centres, Location AMC, Meibergdreef 9, 1105 AZ, the Netherlands.
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Doña I, Salas M, Pérez-Sánchez NI, Moreno-Aguilar C, Torres MJ. Phenotypes and Natural Evolution of Drug Hypersensitivity. CURRENT TREATMENT OPTIONS IN ALLERGY 2019. [DOI: 10.1007/s40521-019-0200-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Positive Skin Test or Specific IgE to Penicillin Does Not Reliably Predict Penicillin Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:676-683. [PMID: 28483318 DOI: 10.1016/j.jaip.2017.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 03/15/2017] [Accepted: 03/20/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION According to guidelines, patients are diagnosed with penicillin allergy if skin test (ST) result or specific IgE (s-IgE) to penicillin is positive. However, the true sensitivity and specificity of these tests are presently not known. OBJECTIVE To investigate the clinical relevance of a positive ST result and positive s-IgE and to study the reproducibility of ST and s-IgE. METHODS A sample of convenience of 25 patients with positive penicillin ST results, antipenicillin s-IgE results, or both was challenged with their culprit penicillin. Further 19 patients were not challenged, but deemed allergic on the basis of a recent anaphylactic reaction or delayed reactions to skin testing. Another sample of convenience of 18 patients, 17 overlapping with the 25 challenged, with initial skin testing and s-IgE (median, 25; range, 3-121), months earlier (T-1), was repeat skin tested and had s-IgE measured (T0), and then skin tested and had s-IgE measured 4 weeks later (T1). RESULTS Only 9 (36%) of 25 were challenge positive. There was an increased probability of being penicillin allergic if both ST result and s-IgE were positive at T0. Positive ST result or positive s-IgE alone did not predict penicillin allergy. Among the 18 patients repeatedly tested, 46.2% (12 of 25) of positive ST results at T-1 were reproducibly positive at T0. For s-IgE, 54.2% (14 of 24) positive measurements were still positive at T0 and 7 converted to positive at T1. CONCLUSIONS The best predictor for a clinically significant (IgE-mediated) penicillin allergy is a combination of a positive case history with simultaneous positive ST result and s-IgE or a positive challenge result.
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Blanca-Lopez N, Perez-Alzate D, Ruano F, Garcimartin M, de la Torre V, Mayorga C, Somoza ML, Perkins J, Blanca M, Canto MG, Torres MJ. Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis. Allergy 2015; 70:1013-9. [PMID: 25913298 DOI: 10.1111/all.12636] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. OBJECTIVE To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX. METHODS Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure. RESULTS Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX-selective cases developed positive responses after re-provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX. DISCUSSION The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely.
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Affiliation(s)
| | | | - F. Ruano
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | | | | | - C. Mayorga
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. L. Somoza
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - J. Perkins
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. Blanca
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
| | - M. G. Canto
- Allergy Service; Hospital Infanta Leonor; Madrid Spain
| | - M. J. Torres
- Allergy Unit; IBIMA; Regional University Hospital of Malaga; Málaga Spain
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Hjortlund J, Mortz CG, Stage TB, Skov PS, Dahl R, Bindslev-Jensen C. Positive serum specific IgE has a short half-life in patients with penicillin allergy and reversal does not always indicate tolerance. Clin Transl Allergy 2014; 4:34. [PMID: 25905005 PMCID: PMC4405882 DOI: 10.1186/2045-7022-4-34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 09/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background The positive and negative predictive values of specific IgE to penicillins are not well established for penicillin hypersensitivity. One reason may be that serum IgE levels to penicillin diminish over time. The objective in this study was to investigate variations in serum half-life (T½) for specific IgE to penicillins (s-IgE) and to evaluate the outcome of penicillin challenges in patients with previous but not present specific IgE to penicillins. Methods Two subgroups were investigated. All included patients had a history of penicillin allergy with reported symptoms such as urticaria/angioedema or unclassified cutaneous rash. T½ of specific IgE to penicillins was calculated based on sera from 29 patients with repeated measurements of s-IgE. Twenty-two patients with a previous positive s-IgE was followed and challenged with penicillin when IgE had become negative. Results The T½ for s-IgE varied between the 26 patients with decreasing s-IgE from 1.6 months to 76.4 months and 52% had a T½ of less than a year. The three patients with stable and increasing IgE-values showed T½ approaching infinity A total of 29 challenges with β-lactams were performed. Four different patterns were seen when evaluating the clinical reaction to challenge (positive/negative) and post-challenge boost of s-IgE (yes/no). Eight (36.4%) had negative challenge and negative post-challenge s-IgE, eight (36.4%) negative challenge, but positive post-challenge s-IgE levels. 3 (13.6%) had positive challenge and positive post-challenge s-IgE whereas 3 (13.6%) were challenge positive, but had negative post-challenge s-IgE. Conclusion Specific IgE to penicillins declines over time stressing the importance of a close time relation between diagnostic work-up and clinical reaction. Reversal of previously positive s-IgE may still be associated with positive penicillin challenges and/or re-boostering of s-IgE to positivity.
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Affiliation(s)
- Janni Hjortlund
- Department of Dermatology and Allergy Centre, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy Centre, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | | | - Per Stahl Skov
- Department of Dermatology and Allergy Centre, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Ronald Dahl
- Department of Dermatology and Allergy Centre, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense C, Denmark
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Trubiano J, Phillips E. Antimicrobial stewardship's new weapon? A review of antibiotic allergy and pathways to 'de-labeling'. Curr Opin Infect Dis 2014; 26:526-37. [PMID: 24126717 DOI: 10.1097/qco.0000000000000006] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW The continued emergence of multiresistant pathogens and widespread antimicrobial use has led to a greater emphasis on antimicrobial stewardship programs. Concurrently, an increased awareness of the rising number of antibiotic allergy labels and impact on antimicrobial use has surfaced. The integration of antibiotic allergy de-labeling and antimicrobial stewardship programs may be a pathway worthy of further focus and investigation. RECENT FINDINGS Recent literature has evaluated the efficacy of antibiotic allergy management (historical de-labeling, in-vitro testing, skin prick testing, intradermal testing, and oral challenges) and impact of antibiotic allergy labels on patient outcome. The importance of true and perceived antibiotic allergy cross-reactivity in the setting of β-lactam allergies has been highlighted. The impact of dedicated antibiotic allergy de-labeling clinics, inpatient antibiotic allergy testing, and integrated antimicrobial stewardship programs has been recently appraised. SUMMARY More recent literature supports that appropriate antibiotic allergy in-vitro and in-vivo testing and subsequent antibiotic allergy de-labeling, particularly in regard to β-lactams, can decrease broad-spectrum antibiotic use, costs, patient length of stay, and mortality. Integration of antibiotic allergy management into the decision support systems of inpatient and outpatient antimicrobial stewardship programs represents an important opportunity to further improve measured outcomes from antibiotic utilization.
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Affiliation(s)
- Jason Trubiano
- aDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria bThe Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia cDepartments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, Khan DA, Lang DM, Park HS, Pichler W, Sanchez-Borges M, Shiohara T, Thong BYH. International Consensus on drug allergy. Allergy 2014; 69:420-37. [PMID: 24697291 DOI: 10.1111/all.12350] [Citation(s) in RCA: 612] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 01/11/2023]
Abstract
When drug reactions resembling allergy occur, they are called drug hypersensitivity reactions (DHRs) before showing the evidence of either drug-specific antibodies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergies being immunologically mediated DHRs. These reactions are typically unpredictable. They can be life-threatening, may require or prolong hospitalization, and may necessitate changes in subsequent therapy. Both underdiagnosis (due to under-reporting) and overdiagnosis (due to an overuse of the term ‘allergy’) are common. A definitive diagnosis of such reactions is required in order to institute adequate treatment options and proper preventive measures. Misclassification based solely on the DHR history without further testing may affect treatment options, result in adverse consequences, and lead to the use of more-expensive or less-effective drugs, in contrast to patients who had undergone a complete drug allergy workup. Several guidelines and/or consensus documents on general or specific drug class-induced DHRs are available to support the medical decision process. The use of standardized systematic approaches for the diagnosis and management of DHRs carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences and deficiencies of evidence, thus providing a comprehensive reference document for the diagnosis and management of DHRs.
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Affiliation(s)
- P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France and Sorbonne Universités; Paris France
| | - N. F. Adkinson
- Division of Allergy and Clinical Immunology; The Johns Hopkins Asthma and Allergy Center; The Hopkins Bayview Medical Campus; Baltimore MD USA
| | - K. Brockow
- Department of Dermatology and Allergology Biederstein; Technische Universität München; Munich Germany
| | - M. Castells
- Division of Rheumatology, Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Boston MA
| | - A. M. Chiriac
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France and Sorbonne Universités; Paris France
| | - P. A. Greenberger
- Division of Allergy-Immunology; Northwestern University Feinberg School of Medicine; Chicago IL
| | - D. A. Khan
- Division of Allergy & Immunology; University of Texas Southwestern Medical Center; Dallas TX
| | - D. M. Lang
- Department of Allergy/Immunology; Respiratory Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - H.-S. Park
- Department of Allergy and Clinical Immunology; Ajou University School of Medicine; Suwon Korea
| | - W. Pichler
- Division of Allergology; Department of Rheumatology and Allergology/Clinical Immunology; Inselspital, University of Bern; Bern Switzerland
| | - M. Sanchez-Borges
- Allergy and Clinical Immunology Department; Centro Medico Docente La Trinidad; Caracas Venezuela
| | - T. Shiohara
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - B. Y.-H. Thong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore
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Barbaud A. Drug skin tests and systemic cutaneous adverse drug reactions: an update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17469872.2.4.481] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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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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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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Kim HB, Kim MJ, Kim DY, Lee JW, Bae JH, Kim DW, Kang CD, Kim SH. High susceptibility of metastatic cells derived from human prostate and colon cancer cells to TRAIL and sensitization of TRAIL-insensitive primary cells to TRAIL by 4,5-dimethoxy-2-nitrobenzaldehyde. Mol Cancer 2011; 10:46. [PMID: 21513580 PMCID: PMC3094320 DOI: 10.1186/1476-4598-10-46] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 04/25/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tumor recurrence and metastasis develop as a result of tumors' acquisition of anti-apoptotic mechanisms and therefore, it is necessary to develop novel effective therapeutics against metastatic cancers. In this study, we showed the differential TRAIL responsiveness of human prostate adenocarcinoma PC3 and human colon carcinoma KM12 cells and their respective highly metastatic PC3-MM2 and KM12L4A sublines and investigated the mechanism underlying high susceptibility of human metastatic cancer cells to TRAIL. RESULTS PC3-MM2 and KM12L4A cells with high level of c-Myc and DNA-PKcs were more susceptible to TRAIL than their poorly metastatic primary PC3 and KM12 cells, which was associated with down-regulation of c-FLIPL/S and Mcl-1 and up-regulation of the TRAIL receptor DR5 but not DR4 in both metastatic cells. Moreover, high susceptibility of these metastatic cells to TRAIL was resulted from TRAIL-induced potent activation of caspase-8, -9, and -3 in comparison with their primary cells, which led to cleavage and down-regulation of DNA-PKcs. Knockdown of c-Myc gene in TRAIL-treated PC3-MM2 cells prevented the increase of DR5 cell surface expression, caspase activation and DNA-PKcs cleavage and attenuated the apoptotic effects of TRAIL. Moreover, the suppression of DNA-PKcs level with siRNA in the cells induced the up-regulation of DR5 and active caspase-8, -9, and -3. We also found that 4,5-dimethoxy-2-nitrobenzaldehyde (DMNB), a specific inhibitor of DNA-PK, potentiated TRAIL-induced cytotoxicity and apoptosis in relatively TRAIL-insensitive PC3 and KM12 cells and therefore functioned as a TRAIL sensitizer. CONCLUSION This study showed the positive relationship between c-Myc expression in highly metastatic human prostate and colon cancer cells and susceptibility to TRAIL-induced apoptosis and therefore indicated that TRAIL might be used as an effective therapeutic modality for advanced metastatic cancers overexpressing c-Myc and combination of TRAIL therapy with agent that inhibits the DNA-PKcs/Akt signaling pathway might be clinically useful for the treatment of relatively TRAIL-insensitive human cancers.
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Affiliation(s)
- Hak-Bong Kim
- Department of Biochemistry, Pusan National University School of Medicine, Yangsan 626-870, South Korea
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Fernández TD, Torres MJ, Blanca-López N, Rodríguez-Bada JL, Gomez E, Canto G, Mayorga C, Blanca M. Negativization rates of IgE radioimmunoassay and basophil activation test in immediate reactions to penicillins. Allergy 2009; 64:242-8. [PMID: 19178404 DOI: 10.1111/j.1398-9995.2008.01713.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Skin test sensitivity in patients with immediate allergy to penicillins tends to decrease over time, but no information is available concerning in vitro tests. We analysed the negativization rates of two in vitro methods that determine specific immunoglobulin E (IgE) antibodies, the basophil activation test using flow cytometry (BAT) and the radioallergosorbent test (RAST), in immediate allergic reactions to penicillins. METHODS Forty-one patients with immediate allergic reactions to amoxicillin were followed up over a 4-year period. BAT and RAST were performed at 6-month intervals. Patients were randomized into groups: Group I, skin tests carried out at regular intervals; Group II, skin tests made only at the beginning of the study. RESULTS Differences were observed between RAST and BAT (P < 0.01), the latter showing earlier negativization. Considering different haptens, significant differences for the rate of negativization were only found for amoxicillin (P < 0.05). Comparisons between Groups I (n = 10) and II (n = 31) showed a tendency to become negative later in Group I with RAST. CONCLUSIONS Levels of specific IgE antibodies tended to decrease over time in patients with immediate allergic reactions to amoxicillin. Conversion to negative took longer for the RAST assay, although the differences were only detected with the amoxicillin hapten. Skin testing influenced the rate of negativization of the RAST assay, contributing to maintenance of in vitro sensitivity. Because of the loss of sensitivity over time, the determination of specific IgE antibodies to penicillins in patients with immediate allergic reactions must be done as soon as possible after the reaction.
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Affiliation(s)
- T D Fernández
- Research Unit for Allergic Diseases, Carlos Haya Hospital, Málaga, Spain
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Current World Literature. Curr Opin Allergy Clin Immunol 2006; 6:303-6. [PMID: 16825874 DOI: 10.1097/01.all.0000235907.33418.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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