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Cheong Z, Tan CYL, Lim CP, Soong JL, Chong CJM, Chan AKW. Patient characterization and predictors of aspirin desensitization response. Asia Pac Allergy 2021; 11:e20. [PMID: 34007830 PMCID: PMC8103003 DOI: 10.5415/apallergy.2021.11.e20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) may limit the use of aspirin in patients with cardiovascular diseases. Aspirin desensitization, which is a resource-intensive process, can offer such patients access to aspirin through the induction of temporary tolerance to aspirin. However, there is limited information on aspirin desensitization response in patients undergoing aspirin desensitization for cardiac indications in Asia. Objective To characterize patients who have undergone aspirin desensitization, evaluate their responses to the procedure, and identify risk factor(s) associated with failure of aspirin desensitization. Methods We conducted a retrospective review of medical records of patients who underwent aspirin desensitization in Singapore General Hospital between 1 June 2014 and 31 October 2017. Chi-square or Fisher exact test were used to analyze categorical data while independent samples t test or Wilcoxon rank-sum test were used for continuous data where appropriate. Multivariate logistic regression was used to identify predictors of aspirin desensitization failure. Results All 214 patients in our study had cardiovascular indications for aspirin, with angioedema being the most common type of index reaction experienced with NSAIDs (n = 104, 48.6%). One hundred sixty-five patients (77.1%) achieved successful aspirin desensitization. In the selected sample analysis of patients with true NSAID hypersensitivity (n = 163), an index reaction of angioedema to NSAIDs was found to be significantly associated with a higher risk of failing aspirin desensitization (odds ratio, 7.21; 95% confidence interval, 1.94–26.71). Conclusion Majority of the patients who underwent aspirin desensitization in our institution were able to achieve tolerance to aspirin. An index reaction of angioedema to NSAIDs was identified as a risk factor for aspirin desensitization failure. This information can aid in the risk stratification of patients undergoing aspirin desensitization and ensure efficient resource allocation for this procedure.
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Shaikhain TA, Al-Husayni F, Elder K. Ibuprofen-induced Anaphylactic Shock in Adult Saudi Patient. Cureus 2019; 11:e6425. [PMID: 31993263 PMCID: PMC6970456 DOI: 10.7759/cureus.6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most prescribed medications globally. They act through inhibiting cyclooxygenase (COX)-1 and COX-2 enzymes. In contrast to other NSAIDs, anaphylaxis due to ibuprofen is quite rare, especially in adults. The management of anaphylaxis depends on early recognition of the symptoms, administering epinephrine, and avoidance of the causing allergen. Here, we report a case of a 23-year-old female who presented with anaphylactic shock after ingesting ibuprofen.
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Affiliation(s)
| | | | - Kareem Elder
- Internal Medicine, National Guard Hospital, Jeddah, SAU
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Lee EY, Teitelbaum D, Chiam M, Vadas P. Characterization of Patients with Ibuprofen Hypersensitivity. Int Arch Allergy Immunol 2018; 178:177-181. [PMID: 30544107 DOI: 10.1159/000494388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ibuprofen is the most frequently used over-the-counter nonsteroidal anti-inflammatory drug (NSAID) in North America. While it has been commonly implicated in drug-induced hypersensitivity reactions, there is limited literature specifically on ibuprofen hypersensitivity. OBJECTIVES To characterize the demographics and clinical course of hypersensitivity reactions in a cohort of patients with ibuprofen allergy. METHODS A retrospective chart review of patients diagnosed with ibuprofen allergy was conducted between 2008 and 2016 in an allergy clinic at a tertiary care academic institution. Demographics and clinical information were obtained, and severity of reactions was assessed by a standardized grading system. RESULTS A total of 41 patients were included of whom 27 were female. The mean age at first reaction to ibuprofen was 33 ± 13.9 years. The medi an time from the first reaction to the time of diagnosis was 1 year (0-3). The median time from ibuprofen exposure to the onset of symptoms was 30 min (16-101). The median duration of symptoms was 180 min (60-1,440). Urticaria and angioedema were seen in 90% of patients. The reactions were either mild (46%) or moderate (51%) in severity, but 1 patient had severe anaphylaxis. Cross-reactivity to other NSAIDs or acetaminophen was seen and presented with mostly mild reactions. CONCLUSION In our cohort of patients, ibuprofen hypersensitivity affected females more commonly than males, and presented with mainly cutaneous manifestations. Onset of symptoms was rapid (< 60 min). Reactions typically ranged in severity from mild to moderate although there was a risk of severe anaphylaxis. There was potential cross-reactivity with other NSAIDs or acetaminophen. The results of our study contribute to the understanding of the demographics and clinical course of ibuprofen hypersensitivity reactions.
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Affiliation(s)
- Erika Yue Lee
- Internal Medicine Resident, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Teitelbaum
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marcus Chiam
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter Vadas
- Division of Allergy and Clinical Immunology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada,
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Behera SK, Das S, Chengappa KG, Xavier AS, Selvarajan S. Multiple Drug Intolerance Syndrome: An Underreported Distinct Clinical Entity. ACTA ACUST UNITED AC 2018; 14:84-90. [PMID: 30417793 PMCID: PMC7011677 DOI: 10.2174/1574884713666181112125714] [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: 10/19/2018] [Revised: 11/01/2018] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
Aim: Multiple drug intolerance syndrome (MDIS) is a unique clinical entity distinct from other drug hypersensitivity syndromes. The aim of this review was to critically appraise the various aspects of MDIS. Methods A review was conducted to search for the causes, mechanism, clinical features, and management of MDIS. Results The most common cause of MDIS is antibiotics followed by non-steroidal anti-inflammatory drugs (NSAIDs). Although some non-specific immunological mechanisms are involved, the immunological tests for MDIS are negative. Rashes, gastrointestinal reflux, headache, cough, muscle ache, fever, dermatitis, hypertension, and psychiatric symptoms are the usual manifestations. Treatment is mostly symptomatic with the withdrawal of the offending drug. Drug re-challenges and desensitization may be required for the management of this syndrome. Conclusion MDIS occurs by a nonimmune mechanism which requires a prompt withdrawal of the offending drug(s), and in some cases may require drug re-challenge and desensitization.
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Affiliation(s)
- Sapan K Behera
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, (JIPMER), Puducherry, India
| | - Saibal Das
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, (JIPMER), Puducherry, India
| | - Kavadichanda G Chengappa
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Alphienes S Xavier
- Department of Pharmacology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India
| | - Sandhiya Selvarajan
- Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, (JIPMER), Puducherry, India
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Tange CE, Kaur A, Verma N, Hickey A, Grigoriadou S, Scott C, Kiani S, Steven R, Ponsford M, El-Shanawany T, Jolles S, Harding S, Parker AR. Quantification of human C1 esterase inhibitor protein using an automated turbidimetric immunoassay. J Clin Lab Anal 2018; 33:e22627. [PMID: 30058083 PMCID: PMC6430339 DOI: 10.1002/jcla.22627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 12/02/2022] Open
Abstract
Background Impaired levels or function of C1 inhibitor (C1‐INH) results in angioedema due to increased bradykinin. It is important to distinguish between angioedema related to C1‐INH deficiency and that caused by other mechanisms, as treatment options are different. In hereditary (HAE) and acquired (AAE) angioedema, C1‐INH concentration is measured to aid patient diagnosis. Here, we describe an automated turbidimetric assay to measure C1‐INH concentration on the Optilite® analyzer. Methods Linearity, precision, and interference were established over a range of C1‐INH concentrations. The 95th percentile reference interval was generated from 120 healthy adult donors. To compare the Optilite C1‐INH assay with a predicate assay used in a clinical laboratory, samples sent for C1‐INH investigation were used. The predicate results were provided to allow comparison. Results The Optilite C1‐INH assay was linear across the measuring range at the standard sample dilution. Intra and interassay variability was <6%. The 95th percentile adult reference interval for the assay was 0.21‐0.38 g/L. There was a strong correlation between the Optilite concentrations and those generated with the predicate assay (R2 = 0.94, P < 0.0001, slope y = 0.83x). All patients with Type I HAE (n = 24) and AAE (n = 3) tested had concentrations below the measuring range in both assays, while all patients with unspecified angioedema (UAE), not diagnosed with HAE or AAE had values within the reference range. Conclusion The Optilite assay allows the automated and precise quantification of C1‐INH concentrations in patient samples. It could therefore be used as a tool to aid the investigation of patients with angioedema.
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Affiliation(s)
| | - Amrit Kaur
- The Binding Site Group Limited, Birmingham, UK
| | | | | | | | | | | | - Rachael Steven
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Mark Ponsford
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Tariq El-Shanawany
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
| | - Stephen Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, UK
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Bernstein JA, Cremonesi P, Hoffmann TK, Hollingsworth J. Angioedema in the emergency department: a practical guide to differential diagnosis and management. Int J Emerg Med 2017; 10:15. [PMID: 28405953 PMCID: PMC5389952 DOI: 10.1186/s12245-017-0141-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 03/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background Angioedema is a common presentation in the emergency department (ED). Airway angioedema can be fatal; therefore, prompt diagnosis and correct treatment are vital. Objective of the review Based on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED. Review The most common pathophysiology underlying angioedema is mediated by histamine; however, ED staff must be alert for the less common bradykinin-mediated forms of angioedema. Crucially, bradykinin-mediated angioedema does not respond to the same treatment as histamine-mediated angioedema. Bradykinin-mediated angioedema can result from many causes, including hereditary defects in C1 esterase inhibitor (C1-INH), side effects of angiotensin-converting enzyme inhibitors (ACEis), or acquired deficiency in C1-INH. The increased use of ACEis in recent decades has resulted in more frequent encounters with ACEi-induced angioedema in the ED; however, surveys have shown that many ED staff may not know how to recognize or manage bradykinin-mediated angioedema, and hospitals may not have specific medications or protocols in place. Conclusion ED physicians must be aware of the different pathophysiologic pathways that lead to angioedema in order to efficiently and effectively manage these potentially fatal conditions.
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Affiliation(s)
- Jonathan A Bernstein
- Division of Immunology/Allergy, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA.
| | - Paolo Cremonesi
- Department of Emergency Medicine, E. O. Galliera Hospital, Genoa, Italy
| | - Thomas K Hoffmann
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - John Hollingsworth
- Department of Emergency Medicine, University Hospital, Aintree, Liverpool, UK
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