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Shaikh S, Raut A, Jambhale P, Iyer S, Shah J. Incidence and Severity of Adverse Drug Reactions in Medical Intensive Care Unit. Curr Drug Saf 2024; 19:332-341. [PMID: 37587829 DOI: 10.2174/1574886318666230816090606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/17/2023] [Accepted: 07/03/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) curtail patients' quality of life by virtue of increasing therapeutic complexity and rising multimorbidity. In India, the frequency of ADRs for individual drugs and their economic burdens are rarely evaluated. This study aimed at identifying the incidence and severity of ADRs leading to hospitalization (ADRA) and occurring during a hospital stay (ADRH). OBJECTIVE The objective of this study is to evaluate the incidence the incidence and severity of ADRs in the ICU and their impact on the duration of hospitalization, along with the cost incurred to treat ADRs in the ICU. METHODS Demographic, clinical, and pharmacological data on patients admitted to the ICU were collected, analyzed and evaluated for ADRs. According to the setting analyzed, a descriptive analysis of the reactions, suspected medicines, and associated factors was undertaken. RESULTS A total of 208 patients were admitted to the ICU during the study period, of which ADRA contributed 9.1% of the incidence rate and 8.1% of ADRH in 36 patients. Males had a higher incidence of ADRs than females. Patients who had ADRs had a substantially longer length of stay than those who did not. Electrolyte disturbance was the most commonly found ADR. According to the Hartwig scale and WHO-causality scale, 88.9% were moderate, and 97.2% were possible ADRs, respectively. CONCLUSION In this study, a similar incidence rate of ADRA and ADRH was observed. The average cost for treating ADRA was higher than that for treating ADRH. As a result, identifying and preventing these reactions is critical, as they cause the patient greater suffering.
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Affiliation(s)
- Sana Shaikh
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Asawari Raut
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Prajkta Jambhale
- Department of Pharmacy Practice, Poona College of Pharmacy, Bharati Vidyapeeth (Deemed to be University), Pune, India
| | - Shivkumar Iyer
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
| | - Jignesh Shah
- Department of Critical Care Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, India
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2
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Bianchi L, Hansel K, Biondi F, Caroppo ES, Galeotti T, Casciola G, Tramontana M, Marietti R, Napolitano M, Patruno C, Stingeni L. Delayed hypersensitivity reactions to iodinated contrast media: A diagnostic approach by skin tests. Contact Dermatitis 2023; 89:352-358. [PMID: 37394777 DOI: 10.1111/cod.14372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/09/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Adverse drug reactions to iodinated contrast media (ICM) have risen due to their increasing use in x-ray-based imaging modalities. Delayed hypersensitivity reactions are mainly caused by nonionic monomeric compounds and represent an issue impacting the diagnostic-therapeutic pathways of cancer, cardiology and surgery patients. OBJECTIVES To prospectively evaluate the usefulness of skin tests in delayed hypersensitivity reactions to ICM and to evaluate the tolerability of iobitridol, a monomeric nonionic low osmolality compound, as a possible safe alternative. METHODS Patients with delayed hypersensitivity reactions to ICM referred to us from 2020 to 2022 were prospectively enrolled in the study. All patients underwent patch test and, if negative, intradermal test with the culprit ICM and iobitridol as alternative. RESULTS A total of 37 patients (females 24, 64.9%) were enrolled in the study. Iodixanol and iomeprol were the most frequently involved ICM (48.5% and 35.2%, respectively); 62.2% of patients presented maculopapular eruption, while 37.8% reported delayed urticaria-like rash. Skin tests resulted positive to the culprit ICM in 19 patients (51.4%), 16 to patch test and 3 to intradermal test. Skin tests with iobitridol, tested as alternative, resulted positive in 3/19 patients (15.8%). All 16 patients with negative results to iobitridol were administered this ICM and tolerated it. CONCLUSIONS In at least half of patients, delayed-type hypersensitivity was demonstrated by skin tests, particularly by patch test. This diagnostic approach resulted simple, cost-effective and safe, not only to confirm the culprit ICM but also to identify iobitridol as feasible alternative.
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Affiliation(s)
- Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Elena Sofia Caroppo
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Tommaso Galeotti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Casciola
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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3
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Tramontana M, Hansel K, Bianchi L, Sensini C, Malatesta N, Stingeni L. Advancing the understanding of allergic contact dermatitis: from pathophysiology to novel therapeutic approaches. Front Med (Lausanne) 2023; 10:1184289. [PMID: 37283623 PMCID: PMC10239928 DOI: 10.3389/fmed.2023.1184289] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/18/2023] [Indexed: 06/08/2023] Open
Abstract
Allergic contact dermatitis (ACD) is a common inflammatory skin disease that, especially when the condition becomes chronic, has a high impact on the quality of life and represents a significant disease burden. ACD represents a type IV delayed-type hypersensitivity reaction that is triggered by contact with an allergen in previously sensitized individuals through the activation of allergen-specific T cells. In the acute phase, it is characterized by eczematous dermatitis, which presents with erythema, edema, vesicles, scaling, and intense itch. Non-eczematous clinical forms are also described (lichenoid, bullous, and lymphomatosis). Lichenification is the most common clinical picture in the chronic phase if the culprit allergen is not found or eliminated. ACD can be associated with both occupational and non-occupational exposure to allergens, representing approximately 90% of occupational skin disorders along with irritant contact dermatitis. Patch testing with suspected allergens is required for a diagnosis. Metals, especially nickel, fragrance mix, isothiazolinones, and para-phenylenediamine, are the most commonly positive allergens in patients patch tested for suspected ACD. The treatment goal is to avoid contact with the culprit agent and use topical and/or systemic corticosteroid therapy.
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Villarreal-González RV, Canel-Paredes A, Arias-Cruz A, Fraga-Olvera A, Delgado-Bañuelos A, Rico-Solís GA, Ochoa-García IV, Jiménez-Sandoval JO, Ramírez-Heredia J, Flores-González JV, Cortés-Grimaldo RM, Zecua-Nájera Y, Ortega-Cisneros M. [Drug allergy: Fundamental aspects in diagnosis and treatment.]. REVISTA ALERGIA MÉXICO 2023; 69:195-213. [PMID: 37218047 DOI: 10.29262/ram.v69i4.1181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/14/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Any substance used as a treatment for any disease can produce harmful or unpleasant events called adverse drug reactions (ADRs). They are due to inherent biological effects of the drug and are caused by immunological and non-immunological mechanisms. OBJECTIVES To describe the immunological mechanisms of hypersensitivity reactions (HSR) to drugs, their epidemiology, risk factors, classification, clinical manifestations, diagnosis, treatment, and prognosis. METHODS A review of the most current literature in English and Spanish was carried out, in the main databases, related to the HSR of various drug groups. RESULTS This study describes the terms used to define ADRs and HSRs, their classification and clinical manifestations, current diagnostic tools, treatment algorithms and prognosis of the most frequently used medications and with the highest prevalence of reported adverse events. CONCLUSION ADRs are a challenging entity, with a complex pathophysiology that has not been fully understood. Its approach requires a careful consideration since not all drugs have validated tests for their diagnosis nor a specific treatment. When indicating the use of any drug, the severity of the disease, the availability of other treatments and the potential risks of developing future adverse events should always be taken into consideration.
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Affiliation(s)
- Rosalaura Virginia Villarreal-González
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alejandra Canel-Paredes
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alfredo Arias-Cruz
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Servicio de Alergia e Inmunología Clínica, Hospital Universitario Dr. José Eleuterio González, Nuevo León, México
| | - Alira Fraga-Olvera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Amerimed, Quintana Roo, México
| | - Angélica Delgado-Bañuelos
- Servicio de Alergia e Inmunología Clínica, Hospital General Regional 58, Instituto Mexicano del Seguro Social, Guanajuato, México
| | | | - Itzel Vianey Ochoa-García
- Departamento de Inmunología clínica y Alergia, Hospital de Especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Jaime Omar Jiménez-Sandoval
- Departamento de Alergia e Inmunología Clínica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital Regional Río Blanco, SESVER, Veracruz, México
| | - Jennifer Ramírez-Heredia
- Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México; Hospital MAC, Irapuato, Guanajuato, México
| | | | - Rosa María Cortés-Grimaldo
- Departamento de Alergia e Inmunología Clínica, Unidad Médica de Alta Especialidad, Hospital de Pediatría del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Jalisco, México
| | - Yahvéh Zecua-Nájera
- Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México; Centro Médico San Carlos, Tlaxcala, México
| | - Margarita Ortega-Cisneros
- Departamento de Inmunología Clínica y Alergia, Unidad Médica de Alta Especialidad, Hospital de especialidades, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social.
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5
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Marietti R, Bianchi L, Hansel K, Casciola G, Biondi F, Tramontana M, Stingeni L. Multiple allergy to cephalosporins confirmed by patch test: From the first to the fifth generation. Contact Dermatitis 2023; 88:487-490. [PMID: 36855909 DOI: 10.1111/cod.14301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/15/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Rossella Marietti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Gabriele Casciola
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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6
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Biondi F, Bianchi L, Tramontana M, Marietti R, D'Arpino A, Hansel K, Stingeni L. Self-reported allergy to medications containing the same excipients as SARS-CoV2 vaccines: importance of skin testing with excipients. Ital J Dermatol Venerol 2023; 158:72-73. [PMID: 36421077 DOI: 10.23736/s2784-8671.22.07410-2] [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]
Affiliation(s)
- Filippo Biondi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy -
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Alessandro D'Arpino
- Hospital Pharmacy Unit, Santa Maria della Misericordia Hospital, Hospital of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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7
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De Marco A, Romita P, Ambrogio F, De Prezzo S, Schinzari L, Foti C. Allergic contact dermatitis due to excipients in topical drugs. Contact Dermatitis 2023; 88:158-160. [PMID: 36331181 DOI: 10.1111/cod.14241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Aurora De Marco
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Serena De Prezzo
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Luca Schinzari
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
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8
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Marietti R, Tramontana M, Hansel K, Bianchi L, Malatesta N, Stingeni L. A challenging case of contact allergy to corticosteroids: The value of epicutaneous testing not only for etiologic diagnosis but also to prevent severe systemic reactions. J Eur Acad Dermatol Venereol 2023; 37:e239-e241. [PMID: 36222492 DOI: 10.1111/jdv.18658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/30/2022] [Indexed: 01/20/2023]
Affiliation(s)
- Rossella Marietti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Nicolò Malatesta
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
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9
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Foti C, Calianno G, Cassano N, Vena GA, Hansel K, Stingeni L, Romita P. Vulvar allergic contact dermatitis to metronidazole. Contact Dermatitis 2023; 88:406-407. [PMID: 36718015 DOI: 10.1111/cod.14283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023]
Affiliation(s)
- Caterina Foti
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Gianluca Calianno
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
| | - Nicoletta Cassano
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Gino Antonio Vena
- Dermatology and Venereology Private Practice, Bari and Barletta, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paolo Romita
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Dermatology, University of Bari Aldo Moro, Piazza Giulio Cesare, Bari, Italy
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10
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Bianchi L, Biondi F, Hansel K, Murgia N, D'Arpino A, Tramontana M, Stingeni L. Mucocutaneous Adverse Reactions to COVID-19 Vaccines: Do Excipients Play a Role? Acta Derm Venereol 2022; 102:adv00724. [PMID: 35535644 PMCID: PMC10508273 DOI: 10.2340/actadv.v102.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract is missing (Short communication)
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Affiliation(s)
| | | | | | | | | | | | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
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11
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Romita P, Foti C, Mennuni BG, Ambrogio F, Poli MA, Tramontana M, Hansel K, Stingeni L. Perioral photoallergic dermatitis to promazine hydrochloride. Contact Dermatitis 2022; 86:561-562. [PMID: 35195295 DOI: 10.1111/cod.14086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Biagina Gisella Mennuni
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Francesca Ambrogio
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Melita Anna Poli
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Italy
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12
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Lyu CX, Zhang JH, Wang BH, Zhang BL, Liu CX, Li YF, Huang YH. Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections. Chin J Integr Med 2021; 28:36-42. [PMID: 34816364 DOI: 10.1007/s11655-021-3523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate whether skin tests are suitable to predict the allergy reactions induced by Chinese herbal injections (CHIs). METHODS The skin tests including skin prick tests (SPT), intradermal tests (IDT) and provocation tests including subcutaneous tests and intravenous tests were administered to 249 healthy subjects and 180 allergic patients for 3 CHIs, including ginkgolide injection, diterpene ginkgolide meglumine injection and Salvianolate lyophilized injection. The results of the provocation tests were used as the "gold standard" to determine the sensitivity and specificity of the skin tests. RESULTS The results did not show any significant differences between the healthy and allergy groups in both skin tests and provocation tests (P>0.05). The specificities of SPT and IDT were 0.976 and 0.797, respectively, and the sensitivities of both SPT and IDT were 0. CONCLUSION Skin tests are insufficient to predict the likelihood of allergic reactions resulting from CHIs. (ChiCTR-CPC-15006921).
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Affiliation(s)
- Chun-Xiao Lyu
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Jun-Hua Zhang
- Research Institute of Traditional Chinese Medicine, Evidence-Based Medicine Centre, Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Bao-He Wang
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Bo-Li Zhang
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Chang-Xiao Liu
- State Key Laboratory of Drug Delivery Technology and Pharmacokinetics, Tianjin Institute of Pharmaceutical Research, Tianjin, 300250, China
| | - Yan-Fen Li
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China
| | - Yu-Hong Huang
- Department of Clinical Pharmacology, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, China.
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13
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Martora F, Fabbrocini G, Marasca C. Pityriasis rosea after Moderna mRNA-1273 vaccine: A case series. Dermatol Ther 2021; 35:e15225. [PMID: 34816549 PMCID: PMC9286452 DOI: 10.1111/dth.15225] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/09/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fabrizio Martora
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Gabriella Fabbrocini
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Claudio Marasca
- Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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14
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Bianchi L, Hansel K, Biondi F, Murgia N, Tramontana M, Stingeni L. Comment on "Caution against injudicious vaccine allergy skin test and adverse reactions after intradermal COVID-19 vaccine testing". Contact Dermatitis 2021; 86:237. [PMID: 34812501 PMCID: PMC9011852 DOI: 10.1111/cod.14014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Affiliation(s)
- Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Filippo Biondi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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15
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Wong J, Sandoval A, Jean T, Naderi AG. A case of delayed maculopapular eruption to ibuprofen and acute urticaria to acetaminophen. SAGE Open Med Case Rep 2021; 9:2050313X211056409. [PMID: 34733518 PMCID: PMC8558799 DOI: 10.1177/2050313x211056409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
We present the unique case of a 33-year-old male referred to our clinic in search of analgesic options who was found to have a delayed hypersensitivity reaction to ibuprofen manifesting as a maculopapular rash and acute urticaria to acetaminophen. Non-steroidal anti-inflammatory drugs are associated with predictable reactions as well as immunoglobulin E-mediated reactions or T-cell mediated reactions. This case highlights the importance of knowledge of the different types of reactions to non-steroidal anti-inflammatory agents as well as the risk of cross reactivity. Delayed reaction to a single non-steroidal agent is rare; urticaria to acetaminophen is very rare. This is the first report we have found in the literature where one individual has a delayed reaction manifesting as rash to ibuprofen as well as urticaria to acetaminophen. We challenged our patient to aspirin which helped identify that his delayed reaction was only to ibuprofen and urticaria only to acetaminophen. The case also highlights the importance of an oral provocation challenge when no contraindications exist which helped us find that he could take celecoxib and avoid narcotics as initial therapy.
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Affiliation(s)
- Jason Wong
- Division of Immunology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Ashley Sandoval
- Division of Immunology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Tiffany Jean
- Division of Immunology, Irvine Medical Center, University of California, Orange, CA, USA
| | - Asal Gharib Naderi
- Division of Immunology, Irvine Medical Center, University of California, Orange, CA, USA
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Stingeni L, Marietti R, Bianchi L, Ferrucci SM, Foti C, Patruno C, Napolitano M, Gallo R, Corazza M, Schena D, Tramontana M, Hansel K. Contact allergy to hydrocortisone 21-acetate in Italy: A SIDAPA multicenter study. Contact Dermatitis 2021; 86:217-219. [PMID: 34726778 DOI: 10.1111/cod.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Silvia Mariel Ferrucci
- UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Rosella Gallo
- Section of Dermatology, DISSAL - University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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17
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Musumeci ML, Caruso G, Trecarichi AC, Micali G. Safety of SARS-CoV-2 vaccines in psoriatic patients treated with biologics: A real life experience. Dermatol Ther 2021; 35:e15177. [PMID: 34699117 PMCID: PMC8646328 DOI: 10.1111/dth.15177] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/07/2021] [Accepted: 10/23/2021] [Indexed: 11/28/2022]
Abstract
Vaccination is the most effective method to prevent and control the SARS‐CoV‐2 infection and biologics are not considered a contraindication for vaccination. The burning question is that safety data are lacking since patients taking drugs affecting the immune system were excluded from clinical trials leading to vaccine approbation. Moreover, it seems that vaccination could worsen psoriasis. We conducted a survey to investigate the safety of SARS‐CoV‐2 vaccines in psoriatic patients treated with biologics. A total of 150 patients with stable plaque psoriasis treated with biologics for at least 2 months were evaluated in a 3 months period. Fifty patients (22 F/28 M; age: 33–83 years) only underwent the first and second doses of SARS‐CoV‐2 vaccines. All patients discontinued their biological agents 10 days before and 10 days after each dose of vaccine. Of these, 24 patients were treated with anti‐TNF, 14 with anti‐IL17, 7 with anti‐IL12‐23, and 5 with anti‐IL23. After the vaccines, all patients were evaluated at day 2, 7, and 14 for local and/or systemic side effects and/or adverse drug reactions to SARS‐CoV‐2 vaccines. None of the patients experienced any side effects or a psoriatic flare. Only one patient treated with infliximab biosimilar referred an exacerbation of psoriasis after vaccine. The remaining 100 patients reported that they did not get the vaccine yet. Our preliminary data confirm that SARS‐CoV‐2 mRNA vaccines are safe for patients with chronic plaque psoriasis treated with biologics and did not trigger psoriasis, although these data should be validated in a larger population. We encourage an early SARS‐CoV‐2 vaccines administration in all psoriatic patients on immunosuppressant drugs.
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18
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Bar J, Godlewicz S, Ingber A, Sprecher E, Slodownik D. Role of Patch Testing in Chronic Spontaneous Urticaria. J Asthma Allergy 2021; 14:1075-1079. [PMID: 34456574 PMCID: PMC8387584 DOI: 10.2147/jaa.s325657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Chronic spontaneous urticaria (CSU) is a common debilitating condition. Although not completely understood, the main pathomechanism involves autoimmune-related mast-cell degranulation. Patch test (PT) is the gold standard for the diagnosis of type IV cutaneous hypersensitivity. The relevance of PT to the diagnosis of CSU is debatable. Objective We aimed at determining the role of PT in selected patients with CSU. Methods In this retrospective study, we reviewed cases of patients referred for patch testing at our clinic. We compared results of patients with CSU (n = 134) and patients with suspected allergic contact dermatitis (n = 680; control group). Results Among patients in the CSU group, 3% of patients had relevant reactions to PT, indicating that contact allergen avoidance resulted in resolution of all skin findings. Metals and textile dyes were the most relevant allergens. No significant differences were found between the groups with regard to the percentage of patients with positive PT and hapten reaction profiles. Patients from the CSU group were significantly older (4.1 years on average, P < 0.05), consisted of more females, and were less likely to have atopic trait (46% vs 58%, P<0.05). Conclusion In some of patients, PT may assist in determining the cause of CSU.
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Affiliation(s)
- Jonathan Bar
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sari Godlewicz
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Arieh Ingber
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eli Sprecher
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel - Aviv University, Tel-Aviv, Israel
| | - Dan Slodownik
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel - Aviv University, Tel-Aviv, Israel
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Bianchi L, Biondi F, Hansel K, Murgia N, Tramontana M, Stingeni L. Skin tests in urticaria/angioedema and flushing to Pfizer-BioNTech SARS-CoV-2 vaccine: Limits of intradermal testing. Allergy 2021; 76:2605-2607. [PMID: 33811344 PMCID: PMC8251329 DOI: 10.1111/all.14839] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Leonardo Bianchi
- Department of Medicine and Surgery Section of Dermatology University of Perugia Perugia Italy
| | - Filippo Biondi
- Department of Medicine and Surgery Section of Dermatology University of Perugia Perugia Italy
| | - Katharina Hansel
- Department of Medicine and Surgery Section of Dermatology University of Perugia Perugia Italy
| | - Nicola Murgia
- Department of Medicine and Surgery Section of Occupational Medicine, Respiratory Diseases and Toxicology University of Perugia Perugia Italy
| | - Marta Tramontana
- Department of Medicine and Surgery Section of Dermatology University of Perugia Perugia Italy
| | - Luca Stingeni
- Department of Medicine and Surgery Section of Dermatology University of Perugia Perugia Italy
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20
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Stingeni L, Bianchi L, Zalaudek I, Pigatto PD, Peris K, Patruno C, Fabbrocini G, Micali G, Napolitano M, Tramontana M, Hansel K. Adverse cutaneous and mucous reactions from anti SARS-CoV-2 vaccines: recommendations from the Italian Society of Dermatology (SIDeMaST). Ital J Dermatol Venerol 2021; 156:115-117. [PMID: 33960747 DOI: 10.23736/s2784-8671.21.06992-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy -
| | - Iris Zalaudek
- Dermatologic Clinic, University of Trieste, Trieste, Italy
| | - Paolo D Pigatto
- Unit of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
| | - Ketty Peris
- Section of Dermatology, Department of Translational Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Cataldo Patruno
- Section of Dermatology, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | | | - Maddalena Napolitano
- Department of Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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21
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Hansel K, Sensini C, Caposciutti P, Marietti R, Tramontana M, Bianchi L, Stingeni L. Systemic allergic dermatitis during tetracaine-hydrochloride patch testing. Contact Dermatitis 2021; 85:596-598. [PMID: 34180549 DOI: 10.1111/cod.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Sensini
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Paola Caposciutti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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22
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Stingeni L, Marietti R, Bianchi L, Guarneri F, Ferrucci SM, Faraci AG, Foti C, Romita P, Patruno C, Napolitano M, Gallo R, Corazza M, Schena D, Milanesi N, Bruni F, Pigatto P, Musumeci ML, Martina E, Piras V, Tramontana M, Hansel K. Patch testing of budesonide in Italy: The SIDAPA baseline series experience, 2018-2019. Contact Dermatitis 2021; 85:317-323. [PMID: 33931866 DOI: 10.1111/cod.13873] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/16/2021] [Accepted: 04/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Budesonide was included in the European Baseline Series in 2000 as the most suitable marker forcorticosteroid hypersensitivity. In the last two decades, a decreasing trend of budesonide allergy has been observed. OBJECTIVES To estimate the prevalence of positive patch test reactions to budesonide in a large, Italian patch test population, characterizing patients according to MOAHLFA index and evaluating the benefit with extended readings of budesonide patch test. METHODS Retrospective analysis of patient demographics and patch test results over a 2-year period (2018-2019) was performed at 14 patch test clinics in Italy. RESULTS Ninety out of 14 544 (0.6%) patients reacted to budesonide 0.01% pet.. Positive reactions were mild in 54.4% and late readings at day 7 showed new positive reactions in 37.8% of patients. The MOAHLFA index showed a significant positive association with male gender, atopic dermatitis, and age >40 years and a significant negative association with hand and face dermatitis. CONCLUSIONS We documented a low prevalence of budesonide allergy in Italy, confirming its decreasing trend recently reported in the literature. Nevertheless, budesonide needs to be maintained in the baseline series for its good ability to detect corticosteroid sensitization.
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Affiliation(s)
- Luca Stingeni
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Rossella Marietti
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabrizio Guarneri
- Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Department, UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Giuseppe Faraci
- Dermatology Department, UOC Dermatologia, Fondazione IRCCS Ca´ Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Physiopathology and Transplantation, University Milan, Milan, Italy
| | - Caterina Foti
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Paolo Romita
- Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy
| | - Cataldo Patruno
- Section of Dermatology, Health Sciences Department, Magna Graecia University, Catanzaro, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Rosella Gallo
- Section of Dermatology, Department of Health Science, DISSAL-University of Genoa, Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Corazza
- Section of Dermatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Donatella Schena
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Nicola Milanesi
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Francesca Bruni
- Dermatology-IRCCS Policlinico di Sant'Orsola-Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Alma Mater Studiorum University of Bologna, Italy
| | - Paolo Pigatto
- Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy
| | | | - Emanuela Martina
- Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy
| | - Viviana Piras
- Dermatological Clinic/UC of Dermatology, Department of Medical Science and Public Health, AOU Cagliari, Cagliari, Italy
| | - Marta Tramontana
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Stingeni L, Francisci D, Bianchi L, Hansel K, Tramontana M, Di Candilo F, Mannarino MR, Pirro M. Severe adverse drug reaction in SARS-CoV-2 infection: AGEP induced by ceftriaxone and confirmed by patch test. Contact Dermatitis 2021; 85:366-368. [PMID: 33834491 PMCID: PMC8250611 DOI: 10.1111/cod.13857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Luca Stingeni
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Daniela Francisci
- Infectious Diseases Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Leonardo Bianchi
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Katharina Hansel
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Marta Tramontana
- Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Francesco Di Candilo
- Infectious Diseases Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | | | - Matteo Pirro
- Internal Medicine Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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