Clinical Manifestations and Genetic Influences in Sulfonamide-Induced Hypersensitivity

Identification and in vitro genotoxicity assessment of forced degradation products of glimepiride and glyburide using HEK cell-based COMET assay

This study focuses on characterizing the forced degradation products of antidiabetic drugs glimepiride (GMD) and glyburide (GBD), with previously unexplored genotoxicity. Drugs underwent stress induced by acid, base, and hydrogen peroxide. For GMD, impurities were profiled and isolated using Hypersil Gold C8 (250 × 10 mm, 5 μ) through semi-preparative HPLC with a fraction collector. For GBD, impurity profiling was performed using semi-preparative HPLC (Hypersil GOLD C18, 250 × 10 mm, 5 μ), and reverse-phase flash chromatography (FP ECOFLEX C18 4 g column) for isolation. Although five GMD and three GBD impurities were detected, only three GMD and two GBD impurities were separated and assessed for purity using analytical RP-HPLC with the purity percentages ranging from 96.6% to 99.9%. LC-Orbitrap MS was used to identify these three GMD impurities (m/z: 408.122, 338.340, 381.160) and two GBD impurities (m/z: 369.065, 325.283). ProTox-II in silico predictions classified all impurities as class 4 and 5, with no positive genotoxicity indications. In vitro comet assays, using HEK cells, indicated that for GMD, impurity 2 and impurity 5 were less genotoxic, whereas impurity 4 exhibited genotoxicity. For GBD, both impurities 1 and 3 were found to be genotoxic, with impurity 3 showing a higher level of genotoxicity than impurity 1.

Genetic Variations and Antibiotic-Related Adverse Events

Antibiotic-related adverse events are common in both adults and children, and knowledge of the factors that favor the development of antibiotic-related adverse events is essential to limit their occurrence and severity. Genetics can condition the development of antibiotic-related adverse events, and the screening of patients with supposed or demonstrated specific genetic mutations may reduce drug-related adverse events. This narrative review discusses which genetic variations may influence the risk of antibiotic-related adverse events and which conclusions can be applied to clinical practice. An analysis of the literature showed that defined associations between genetic variations and specific adverse events are very few and that, at the moment, none of them have led to the implementation of a systematic screening process for patients that must be treated with a given antibiotic in order to select those at risk of specific adverse events. On the other hand, in most of the cases, more than one variation is implicated in the determination of adverse events, and this can be a limitation in planning a systematic screening. Moreover, presently, the methods used to establish whether a patient carries a "dangerous" genetic mutation require too much time and waiting for the result of the test can be deleterious for those patients urgently requiring therapy. Further studies are needed to definitively confirm which genetic variations are responsible for an increased risk of a well-defined adverse event.

Simple, fast and eco-friendly micro-solid phase extraction based on thiol and ionic liquid bi-functional nanofibers membrane for the determination of sulfonamides in environmental water

BACKGROUND

Sulfonamides (SAs) are a class of synthetic antibacterial agents that are diffusely used in the medical industry and animal husbandry. Their prevalence in the influents and effluents of water treatment plants, as well as in rivers and groundwater, has provoked worldwide concern. Monitoring SAs in environmental water is of great significance for public health. However, most of the available detection techniques for SAs are cumbersome and time-consuming. With the increasing number of actual samples, simple, fast and environmentally friendly analytical methods are always in demand.

RESULTS

Herein, we describe a highly efficient micro-solid phase extraction (μ-SPE) sample preparation technique based on a novel thiol and ionic liquid bi-functional nanofibers membrane (IL-SH-PAN NFsM) for multi-residue detection of sulfonamides (SAs) in water samples. By the synergistic effect of -SH and -IL, the as-prepared IL-SH-PAN NFsM demonstrated high adsorption capacity and excellent selectivity for SAs. The water samples can be directly used for μ-SPE without pH and ionic strength adjustment, and the eluent can be directly collected for HPLC-MS/MS analysis. Compared with other methods reported in the literature, this method required much shorter extraction time (2 min for a batch), much less amount of adsorbent (4.0 mg) and organic solvent (0.5 mL), while providing much higher sensitivity (1.4-3.9 ng L-1), and fine recoveries (88.8%-117.7%) with relative standard deviations less than 4.26%.

SIGNIFICANCE AND NOVELTY

A bi-functional nanofibers membrane was prepared for efficient extraction of SAs. The adsorbent exhibited superior adsorption performance and excellent selectivity. The underlying interaction mechanisms derived from -SH and -IL were proposed, which provide a new idea for preparing versatile adsorbents. Rapid, efficient and sensitive detection of SAs in water was achieved. The novel sample preparation technique can be expected as an efficient method for routine trace SAs residue monitoring in various water samples.

A Comprehensive Review of Sulfonamide Hypersensitivity: Implications for Clinical Practice

Sulfonamides, which are drugs commonly prescribed in hospital and outpatient settings, have historically been associated with a high incidence of hypersensitivity reactions. It is believed that there is an increased risk of cross-reactions with other drugs that contain this functional group in their structure. However, it has not been conclusively established that the sulfonamide group is the sole cause of hypersensitivity reactions, as non-antibiotic sulfonamides do not share the same accessory groups with antibiotic sulfonamides. Therefore, cross-reactivity between different types of sulfonamides and sulfonamide-type antibiotics is not clearly demonstrated, and allergic reactions may involve other mechanisms. Misinformation about this topic can lead to inappropriate use of alternative antibiotics with lower efficacy or higher adverse effects, contributing to antibiotic resistance. It is crucial to individualize and monitor patients with a history of allergies to sulfonamide-type antibiotics when introducing a new drug containing sulfa and manage any adverse reactions promptly. Desensitization protocols may be a viable option for patients who specifically benefit from these antibiotics, particularly those who are immunosuppressed. This article provides a descriptive bibliographic review to update information on sulfa allergy, its prevalence, management, and recommendations to prevent such reactions and optimize pharmacotherapy, without underusing these drugs.

Causes of Drug-Induced Severe Cutaneous Adverse Reaction Epidermal Necrolysis (EN): An Analysis Using FDA Adverse Event Reporting System (FAERS) Database

Purpose

The purpose of the study is to analyze FAERS data to identify drugs associated with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), determine demographics, drug classes involved, most likely resulted in death, and highlight emerging trends in SJS/TEN reactions.

Patients and Methods

We reviewed the publicly available FAERS database from 2004-2021. Using search terms "Stevens-Johnson syndrome" or "Toxic epidermal necrolysis", we identified the reports of SJS/TEN or SJS/TEN followed by death that might associated with specific drugs. Then the amounts and trends were counted analyzed.

Results

During the study period of 2004-2021, the Food and Drug Administration (FDA) received a total of 14,363,139 reports of adverse reactions, among which 24,976 were linked to SJS or TEN. After excluding the cases with incomplete or insufficient information on age, gender, or country of origin, the median median age of patients was 53.82 (IQR = 57.52), the females accounted for 56.59% (12,827 cases) and 8,507 (38.34%) originated in the United States. The top 50 drugs were associated with 15,149 cases (60.65%). The subsequent fatal outcome occurring in 4878 out of 24,976 cases (19.53%). Top 3 drug classes associated with SJS/TEN in FAERS were antiepileptics, non-steroidal anti-inflammatory drugs (NSAIDs) and others. Top drug classes associated with SJS/TEN deaths were antineoplastic agents and cephalosporins. Linear regression showed that the annual percentage of monoclonal antibody-related SJS/TEN reactions increased at an average rate of 0.25% (95% confidence interval: 0.18, 0.32) from 0.00% in 2004 to 4.79% in 2021, faster than any other drug class except antigout drug (allopurinol).

Conclusion

By using the publicly available FAERS data, we have identified some important themes and trends in drug-related SJS/TEN reactions. Monoclonal antibodies and proton pump inhibitors are drugs with emerging trends causing SJS/TEN. Additionally, cephalosporin antibiotics have a higher mortality rate following SJS/TEN.

Current understanding of genetic associations with delayed hypersensitivity reactions induced by antibiotics and anti-osteoporotic drugs

Drug-induced delayed hypersensitivity reactions (DHRs) is still a clinical and healthcare burden in every country. Increasing reports of DHRs have caught our attention to explore the genetic relationship, especially life-threatening severe cutaneous adverse drug reactions (SCARs), including acute generalized exanthematous pustulosis (AGEP), drug reactions with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). In recent years, many studies have investigated the immune mechanism and genetic markers of DHRs. Besides, several studies have stated the associations between antibiotics-as well as anti-osteoporotic drugs (AOD)-induced SCARs and specific human leukocyte antigens (HLA) alleles. Strong associations between drugs and HLA alleles such as co-trimoxazole-induced DRESS and HLA-B*13:01 (Odds ratio (OR) = 45), dapsone-DRESS and HLA-B*13:01 (OR = 122.1), vancomycin-DRESS and HLA-A*32:01 (OR = 403), clindamycin-DHRs and HLA-B*15:27 (OR = 55.6), and strontium ranelate (SR)-SJS/TEN and HLA-A*33:03 (OR = 25.97) are listed. We summarized the immune mechanism of SCARs, update the latest knowledge of pharmacogenomics of antibiotics- and AOD-induced SCARs, and indicate the potential clinical use of these genetic markers for SCARs prevention in this mini review article.

The status and natural impact of floriculture production in Ethiopia: a systematic review

Ethiopia's floriculture industry is exceedingly emerging, and, currently, it ranks as the sixth largest exporter of roses worldwide and second largest in Africa. Currently, many flowers, such as rose, gypsophila, carnations, and chrysanthemum, are growing. However, floriculture farms are contributing a high level of health risks and environmental problems in Ethiopia. Thus, the purpose of this paper is to scrutinize the status and impacts of floriculture industries in Ethiopia. The floriculture division is an emerging sector in Ethiopia, and the number of farms, income, job opportunities, and diversity of flowers are increasing. However, the health risks and environmental fates of the sector are also increasing. Ethiopian floriculture farms lack waste disposal technologies and workers' protective equipment and safety, and the chemicals, plastics, and corrugated irons used in the farms are carelessly disposed everywhere. Pesticides, plastics, and fertilizers are also freely discharged into water bodies and terrestrial land, which is causing the development of health risks; aquatic life hazards; and soil, water, and air pollution. However, Ethiopia has no strong and functional system or structure to control the impacts of floriculture farms. The government and the farm owners are not thoughtful about the environmental issues, health concerns, and socioeconomic impacts of the wastes. The government lacks regular control and assessment of farms, and the farms are engaging for their profit. Nevertheless, developed countries are currently using both natural and modern technologies to manage floricultural wastes. Ethiopia should therefore suggest manageable possible approaches and sound management strategies based on the findings of the analyses.

Case report: Alpelisib-induced Stevens–Johnson syndrome

Background

Alpelisib is a recently approved treatment for hormone receptor-positive, HER2-negative, PIK3CA-mutated advanced breast cancer. It has been associated with alopecia and rash, but there are no documented cases of Stevens–Johnson Syndrome (SJS) associated with this drug. Here, we detail the first case of SJS associated with alpelisib.

Case description

Our patient is a 60-year-old woman with a past medical history of metastatic hormone receptor-positive (ER+ 80% and PR+ 1%), HER2-negative metastatic breast cancer who presented with acute odynophagia, fevers, and diffuse body rash after receiving her first doses of alpelisib and fulvestrant in the preceding days. She presented to the emergency department after developing a whole-body rash and severe ulceration of her buccal mucosa. She was started on methylprednisolone with remarkable improvement in symptoms.

Conclusion

This case report details the only report of SJS following alpelisib treatment. Immediate cessation of drugs and initiation of steroids are the cornerstone of treatment. Patients who experience such side effects will have to be monitored closely for long-term sequelae associated with SJS, including cutaneous, ocular, and oral sequelae, all of which can profoundly affect the quality of life for cancer patients.