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Meason C, Salazar R, Gentry CM. Alfaxalone provides reliable sedation for intradermal allergen testing in dogs and does not significantly affect results when compared to dexmedetomidine. Vet Dermatol 2023; 34:404-414. [PMID: 37286524 DOI: 10.1111/vde.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Dexmedetomidine (Dexmedetomidine hydrochloride-Dexdomitor; Zoetis) is the preferred sedative used for canine intradermal allergen testing (IDT) in the United States. Alfaxalone (Alfaxan Multidose; Jurox Animal Health) is a neuroactive steroid, and its effect on sedation and allergen reactivity scores is unknown. HYPOTHESIS/OBJECTIVES We hypothesised that alfaxalone would produce an adequate level of sedation with fewer cardiovascular adverse effects and would not affect allergen reactivity scores or histamine wheal size compared to dexmedetomidine. MATERIALS AND METHODS Twenty client-owned dogs were included in two groups: 10 atopic and 10 nonatopic. In a randomised, controlled, blinded, cross-over design all dogs underwent two modified IDT, 1-4 weeks apart, using intravenous dexmedetomidine (2.87-5.22 μg/kg) or alfaxalone (1.8-2.4 mg/kg). Anaesthetic parameters and sedation level were recorded over 25 min using a validated canine sedation scale described by Grint et al. (Small Anim Pract, 2009, 50, 62). Simultaneously, both objective and subjective reactivity scores were measured in technical triplicates at 10, 15 and 20 min. The modified IDT included eight allergens, histamine-positive and saline-negative controls. RESULTS Alfaxalone produced a significantly higher sedation score across all time points (p < 0.05). All objective scores were significantly correlated to the corresponding subjective scores (Spearman R = 0.859, p < 0.0001). Sedative used did not significantly affect subjective allergen scores for nine atopic dogs (p > 0.05, 15 min). Sedative used did not affect the diameter of objective scores for individual allergens and histamine wheals (p > 0.05, 15 min). CONCLUSIONS AND CLINICAL RELEVANCE Intravascular alfaxalone is an alternative sedative for IDT in dogs. Alfaxalone may be preferred to dexmedetomidine in some clinical scenarios as a result of having fewer cardiovascular adverse effects.
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Barbaud A, Castagna J, Soria A. Skin Tests in The Work-Up of Cutaneous Adverse Drug Reactions: A Review and Update. Contact Dermatitis 2022; 86:344-356. [PMID: 35122269 DOI: 10.1111/cod.14063] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Julie Castagna
- AP-HP, Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Angèle Soria
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Département de dermatologie et d'allergologie, 4 rue de la Chine, Paris
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Zaiem A, Ben Hammamia S, Ben Salem F, Charfi O, Aouinti I, Kastalli S, Aidli SE, Badri T, Lakhoua G, Mizouni H. Skin tests for the exploration of hypersensitivity reactions associated with iodinated contrast media. Curr Drug Saf 2021; 17:169-175. [PMID: 34561992 DOI: 10.2174/1574886316666210923143012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/06/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Iodinated contrast media (ICM) are responsible for multiple side effects, especially hypersensitivity reactions. These reactions can either be authentic allergies, or non-allergic hypersensitivity reactions. Skin tests (prick and intradermal tests) are simple to perform and can be of great help, especially if the ICM need to be re-used. The aim of the study was to assess the characteristics of the patients in whom skin tests were performed, and the results of these tests. METHODS This is a retrospective study from June 2014 to June 2019. All included patients had at least one episode of hypersensitivity reaction to ICM and underwent skin tests. RESULTS We included 35 patients aged 18 to 85 years. The iopromide was the most implicated ICM. The reactions were mainly cutaneous (n=30) and immediate (n=27). The skin tests were negative, except for two patients. The reuse of ICM occured in 11 patients: 9 with an ICM other than the one suspected and two patients with the same ICM. Among these patients, 5 did not have any premedication. Two of them had a second hypersensitivity reaction, the first with another ICM and the second with the same ICM. CONCLUSION One of the main pillars of allergic exploration is ICM skin testing, not only to prevent recurrence, but also to allow patients to benefit from ICM reuse, which are sometimes essential.
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Affiliation(s)
- Ahmed Zaiem
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Syrine Ben Hammamia
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Fares Ben Salem
- Radiology department, la Rabta Hospital, Rue Jabbari 1007 Tunis. Tunisia
| | - Ons Charfi
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Imen Aouinti
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Sarrah Kastalli
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Sihem El Aidli
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Talel Badri
- University of Tunis El Manar, Faculty of Medicine, 15 Rue DjebelLakhdhar, La Rabta, 1007, Tunis. Tunisia
| | - Ghozlane Lakhoua
- National Center of Pharmacovigilance, 9 Avenue du Dr Zouhaier Essafi 1006, Tunis. Tunisia
| | - Habiba Mizouni
- Radiology department, la Rabta Hospital, Rue Jabbari 1007 Tunis. Tunisia
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Ortega J, Roy Á, Álvarez J, Sánchez-Cesteros J, Romero B, Infantes-Lorenzo JA, Sáez JL, López M, Domínguez L, de Juan L, Bezos J. Effect of the Inoculation Site of Bovine and Avian Purified Protein Derivatives (PPDs) on the Performance of the Intradermal Tuberculin Test in Goats From Tuberculosis-Free and Infected Herds. Front Vet Sci 2021; 8:722825. [PMID: 34513976 PMCID: PMC8429842 DOI: 10.3389/fvets.2021.722825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/27/2021] [Indexed: 11/18/2022] Open
Abstract
The single and comparative intradermal tuberculin (SIT and CIT) tests are used for the ante-mortem diagnosis of caprine tuberculosis (TB). The tuberculin injection site has been associated with a different performance of the test in cattle. In contrast to that required in cattle in Europe (cervical injection), it can be carried out in the scapular region in goats. Nevertheless, there are no previous data concerning the effect of the injection site on the performance of the test in goats. The aim of the present study was to evaluate the effect of two different inoculation sites (cervical and scapular) on the performance of the SIT/CIT tests. This was done by intradermally inoculating 309 goats from two infected herds and one TB-free herd with both avian and bovine PPDs in the mid-cervical and scapular regions. None of the animals from the TB-free herd had positive reactions, and the number of reactors was not significantly higher, regardless of the inoculation site, in the high and low prevalence herds. However, significantly higher increases in skin fold thickness were observed on the cervical site when compared to the scapular site after the avian and bovine PPD inoculations in the TB-free herd (p < 0.001) and after the bovine PPD injection in the high prevalence herd (p = 0.003). The presence of clinical signs was also more evident on the cervical site when using avian and bovine PPDs in the high prevalence herd (p < 0.01). In contrast, increases in higher skin fold thickness were observed on the scapular site when compared to the cervical site after the bovine and avian PPD inoculations were employed in the low prevalence herd (p < 0.01). These results suggest that the cervical injection of PPDs may improve the sensitivity of the intradermal tuberculin test in high TB prevalence caprine herds, mainly owing to the increased presence of local clinical signs and a better performance of the CIT test. Moreover, specificity was not affected when using standard interpretations, although further analyses in a great number of herds are required in order to confirm these findings.
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Affiliation(s)
- Javier Ortega
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Álvaro Roy
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain
| | - Julio Álvarez
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Beatriz Romero
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain
| | - Jose A Infantes-Lorenzo
- Servicio de Inmunología Microbiana, Centro Nacional de Microbiología, Instituto de Investigación Carlos III, Majadahonda, Spain
| | - José L Sáez
- Ministerio de Agricultura, Pesca y Alimentación, Madrid, Spain
| | - Marisol López
- Servicio Territorial de Agricultura, Ganadería y Desarrollo Rural de Ávila- Sección de Sanidad y Producción Animal, Ávila, Spain
| | - Lucas Domínguez
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Lucia de Juan
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
| | - Javier Bezos
- VISAVET Health Surveillance Centre, Complutense University of Madrid, Madrid, Spain.,Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad Complutense de Madrid, Madrid, Spain
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Teles A, Ribeiro-Mourão F, Branco M, Araújo AR, Vieira T. Paracetamol Allergy: A Case of a 9-Year-Old Female with a History of Atopy. Pediatr Allergy Immunol Pulmonol 2021; 34:80-82. [PMID: 34143688 DOI: 10.1089/ped.2021.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: We describe a rare case involving paracetamol, a commonly used drug worldwide. Increased paracetamol consumption increases the risk of adverse drug reactions. Case Presentation: This is a case of a 9-year-old girl who visited the emergency department due to sudden onset sneezing, nasal itching, urticaria, and angioedema after paracetamol ingestion. The diagnostic and etiologic studies revealed an immunoglobulin E (IgE)-mediated hypersensitivity mechanism to paracetamol. Conclusion: Few cases of this phenomenon have been reported in previous literature. As confirmed in this study, a negative skin prick test did not exclude hypersensitivity, and conducting intradermal tests (IDTs) increased diagnostic accuracy. The patient had a positive IDT, confirming the underlying IgE-mediated reaction. The follow-up of a confirmed paracetamol hypersensitivity implies patient education about avoidance of any paracetamol-containing formulation, including combination products and clarification of available alternative drugs. This is likely the first publication documenting IgE-mediated paracetamol allergy in pediatric patients. We intend to underline the clinical benefits of diagnostic confirmation toward suspected drug hypersensitivity reactions in children, a particularly useful topic for pediatricians and pediatric allergists.
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Affiliation(s)
- Ariana Teles
- Department of Pediatrics and Department of Allergy and Immunology, Hospital Santa Luzia de Viana do Castelo, Viana do Castelo, Portugal
| | - Francisco Ribeiro-Mourão
- Department of Pediatrics and Department of Allergy and Immunology, Hospital Santa Luzia de Viana do Castelo, Viana do Castelo, Portugal
| | - Mariana Branco
- Department of Pediatrics and Department of Allergy and Immunology, Hospital Santa Luzia de Viana do Castelo, Viana do Castelo, Portugal
| | - Ana Rita Araújo
- Department of Pediatrics and Department of Allergy and Immunology, Hospital Santa Luzia de Viana do Castelo, Viana do Castelo, Portugal
| | - Teresa Vieira
- Department of Pediatrics and Department of Allergy and Immunology, Hospital Santa Luzia de Viana do Castelo, Viana do Castelo, Portugal
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Koca Kalkan I, Koycu Buhari G, Ates H, Basa Akdogan B, Erdem Ozdedeoglu O, Aksu K, Oner Erkekol F. Identification of Risk Factors and Cross-Reactivity of Local Anesthetics Hypersensitivity: Analysis of 14-Years' Experience. J Asthma Allergy 2021; 14:47-58. [PMID: 33519213 PMCID: PMC7837570 DOI: 10.2147/jaa.s292442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Local anesthetics (LA) are widely used and adverse drug reactions (ADR) occur in 2.5–10%, but hypersensitivity reactions are rare (ranging between 0% and 4.3%). Risk is so overestimated causing too many allergy clinic referrals. There are limited and also conflicting results over the management of LA allergy. We aimed to find out who should be referred to an allergy clinic for a LA allergy testing, to define the subjects with an increased risk of LA allergy and to assess the need for testing for identifying alternative LA. Patients and Methods We performed a retrospective study of patients referred to our clinic for diagnostic workup of LA hypersensitivity from 2006 to 2020. Results In our cohort of 398 patients, tests were positive in 14 (3.52%) of them. Personal history of ADR with LA was the only independent risk factor for positive test (RR=4.007, p=0.033). Presence of generalized cutaneous symptoms and hypotension during past reaction were independent predictors of positive test (RR=9.043, p=0.021 and RR=10.445, p=0.038, respectively). The negative predictive value of intradermal test at dilution of 1:100 for immediate-type reaction was high (97.56%). Also, we demonstrated cross-reactivity within the amide-group LAs and co-occurrence of immediate- and delayed-type reactions. Conclusion Only patients with an LA-induced ADR should be referred to an allergy clinic. History of generalized cutaneous symptoms and/or hypotension during the reaction may define subjects with an increased risk of LA allergy. A stepwise test procedure may start with skin tests especially for these patients with increased risk factors. In presence of LA allergy, alternative LA should always be confirmed by performing a challenge test.
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Affiliation(s)
- Ilkay Koca Kalkan
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Gozde Koycu Buhari
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Hale Ates
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Buket Basa Akdogan
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ozlem Erdem Ozdedeoglu
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Kurtulus Aksu
- Department of Immunology and Allergy, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Ferda Oner Erkekol
- Division of Immunology and Allergy, Department of Chest Diseases, Ankara Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
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7
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Kim SR, Park KH, Hong YJ, Oh YT, Park JW, Lee JH. Intradermal Testing With Radiocontrast Media to Prevent Recurrent Adverse Reactions. AJR Am J Roentgenol 2019; 213:1187-93. [PMID: 31414881 DOI: 10.2214/AJR.19.21547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE. Adverse drug reactions (ADRs) to radiocontrast media are a significant social and economic burden and are difficult to predict. Because some ADRs to radiocontrast media may be immunologically induced, a skin test with diluted 1:10 radiocontrast media has been used to predict ADRs. However, using this test in clinical practice is difficult because of its low sensitivity. SUBJECTS AND METHODS. This study enrolled 36 patients with a history of immediate ADR to radiocontrast media who visited the Allergy and Asthma Clinic of Severance Hospital from 2017 to 2018. Patients underwent intradermal testing (IDT) with five types of diluted (1:10) and undiluted radiocontrast media (iohexol, iobitridol, iopamidol, iopromide, and iodixanol). The IDT result was regarded as positive if at least one radiocontrast medium elicited a positive reaction. Positivity of IDT and sensitivity to the culprit radiocontrast medium were calculated and compared. For subsequent CT examinations with a radiocontrast medium, the contrast agent eliciting a negative skin reaction in IDT was selected, excluding the previous culprit radiocontrast medium. RESULTS. IDT positivity and sensitivity for the culprit radiocontrast medium at 1:10 dilution were 47.2% and 47.2%, respectively, whereas the positivity and sensitivity for the undiluted radiocontrast medium were 86.1% and 75.0%, respectively. The positivity and sensitivity were higher with frequent radiocontrast medium use or with severe reaction. Of 22 patients who underwent another CT examination with the contrast medium selected on the basis of IDT results, 21 (95.5%) did not experience an ADR. CONCLUSION. IDT to prevent ADR should be performed with undiluted radiocontrast medium. Selecting an alternative radiocontrast agent on the basis of IDT results can be clinically useful to prevent recurrent ADRs to radiocontrast media.
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Yang MS, Kang D, Seo B, Park HJ, Park SY, Kim MY, Park K, Koo SM, Nam YH, Kim S, Jung JW, Kim TB, Jang GC, Yang HJ, Ahn YM, Park JW, Kang HR. Incidence of cephalosporin-induced anaphylaxis and clinical efficacy of screening intradermal tests with cephalosporins: A large multicenter retrospective cohort study. Allergy 2018. [PMID: 29517808 DOI: 10.1111/all.13435] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few studies have investigated the incidence of anaphylaxis induced by individual or structurally similar cephalosporins. The aims of the study were to assess the incidence of cephalosporin-induced anaphylaxis and evaluate the clinical efficacy of screening skin tests. METHODS In this retrospective cohort study, we obtained information on total cephalosporin use and cephalosporin-induced anaphylaxis in intravenous cephalosporin recipients in 12 general hospitals between 2013 and 2015. Cephalosporins were divided into 4 groups according to similar side-chain structures. The incidence of cephalosporin-induced anaphylaxis was assessed for each cephalosporin, cephalosporin generation, and side-chain group. To verify the efficacy of screening intradermal tests (IDT) with cephalosporin, the 12 hospitals were assigned to the intervention or control group depending on whether they performed screening IDT before the administration of cephalosporins. RESULTS We identified 76 cases of cephalosporin-induced anaphylaxis with 1 123 345 exposures to intravenous cephalosporins (6.8 per 100 000 exposures), and the incidence of fatal anaphylaxis by cephalosporin was 0.1 cases per 100 000 exposures. The highest incidences of anaphylaxis occurred in the ceftizoxime (13.0 cases per 100 000 exposures) and side-chain group 1 (cefepime, cefotaxime, ceftizoxime, ceftriaxone, and cefuroxime; 9.3 per 100 000). There was no case of anaphylaxis induced by cefoxitin, cefmetazole, cefminox, and cefotiam. The clinical effectiveness of routine screening IDT was not significant (P = .06). CONCLUSIONS The incidence of cephalosporin-induced anaphylaxis differed according to individual drugs and side-chain structure. Screening IDT showed no clinical efficacy at a population level.
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Affiliation(s)
- M.-S. Yang
- Department of Internal Medicine; SMG-SNU Boramae Medical Center; Seoul Korea
| | - D.Y. Kang
- Department of Preventive Medicine; Seoul National University College of Medicine; Seoul Korea
- Drug Safety Monitoring Center; Seoul National University Hospital; Seoul Korea
| | - B. Seo
- Department of Allergy and Clinical Immunology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - H. J. Park
- Department of Internal Medicine; Gangnam Severance Hospital; Yonsei University College of Medicine; Seoul Korea
| | - S.-Y. Park
- Department of Internal Medicine; Eulji General Hospital; Eulji University School of Medicine; Seoul Korea
| | - M.-Y. Kim
- Division of Pulmonary, Allergy and Critical Care Medicine; Department of Internal Medicine; Busan Paik Hospital; Inje University College of Medicine; Busan Korea
| | - K. H. Park
- Division of Allergy and Immunology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Korea
| | - S.-M. Koo
- Division of Allergy and Respiratory Medicine; Department of Internal Medicine; Soonchunhyang University Seoul Hospital; Soonchunhyang University College of Medicine; Seoul Korea
| | - Y.-H. Nam
- Department of Internal Medicine; Dong-A University College of Medicine; Busan Korea
| | - S. Kim
- Department of Internal Medicine; School of Medicine; Kyungpook National University; Daegu Korea
| | - J.-W. Jung
- Department of Internal Medicine; Chung-Ang University College of Medicine; Seoul Korea
| | - T.-B. Kim
- Department of Allergy and Clinical Immunology; Asan Medical Center; University of Ulsan College of Medicine; Seoul Korea
| | - G. C. Jang
- Department of Pediatrics; National Health Insurance Service; Ilsan Hospital; Goyang Korea
| | - H.-J. Yang
- Pediatric Allergy and Respiratory Center; Department of Pediatrics; Soonchunhyang University Seoul Hospital; Soonchunhyang University College of Medicine; Seoul Korea
| | - Y.-M. Ahn
- Department of Pediatrics; Eulji General Hospital; Eulji University School of Medicine; Seoul Korea
| | - J.-W. Park
- Division of Allergy and Immunology; Department of Internal Medicine; Yonsei University College of Medicine; Seoul Korea
| | - H.-R. Kang
- Drug Safety Monitoring Center; Seoul National University Hospital; Seoul Korea
- Division of Allergy and Clinical Immunology; Department of Internal Medicine; Seoul National University Hospital; Seoul National University College of Medicine; Seoul Korea
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
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Lezmi G, Alrowaishdi F, Bados-Albiero A, Scheinmann P, de Blic J, Ponvert C. Non-immediate-reading skin tests and prolonged challenges in non-immediate hypersensitivity to beta-lactams in children. Pediatr Allergy Immunol 2018; 29:84-89. [PMID: 29047169 DOI: 10.1111/pai.12826] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND A minority of children reporting non-immediate reactions to beta-lactams (BLs) are allergic. Allergy workup usually includes late-reading (48-72 hours) skin tests (ST) and short (1-3 days) drug provocation tests (DPT), regardless of the chronology of the index reaction. The sensitivity of hyper-late-reading (≥6-7 days) ST and of prolonged DPT for the diagnosis of non-immediate hypersensitivity to BLs is yet to be determined. OBJECTIVES To establish the diagnostic values of late-reading ST and hyper-late-reading ST and of prolonged DPT in children reporting non-immediate reactions to BLs. METHODS Prospective assessment of children reporting non-immediate reactions to BLs with late- and additional hyper-late-reading intradermal (ID) and patch tests, and if negative, with prolonged DPT. RESULTS Five hundred and fifty children reporting reactions to a single or several BLs (674 suspected BLs) were included. Non-immediate hypersensitivity to BLs was diagnosed in 63 children (11.5%), reporting 66 reactions (9.8%), based on responses in ST (n = 17, 25.8%: 5 to ID, 8 to patch tests, and 4 to both tests), DPT (n = 43, 65.2%), and clinical history (n = 6, 9.1%), including 3/9 children with severe cutaneous adverse reactions. Skin test positivity was observed after the 6-7th day in 14/17 children, and DPT positivity after a median time of 3 days. No severe reaction was observed after ST or during prolonged DPT. CONCLUSION Additional hyper-late-reading of ST enhanced their positivity. However, their overall sensitivity remained weak, especially in non-severe cases. Prolonged DPT are safe and may improve the performance of DPT in the diagnosis of non-immediate hypersensitivity to BLs.
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Affiliation(s)
- G Lezmi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - F Alrowaishdi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France
| | | | - P Scheinmann
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - J de Blic
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
| | - C Ponvert
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'allergologie Pédiatriques, Paris, France.,Université Paris Descartes, Paris, France
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10
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Berti A, Della-Torre E, Yacoub M, Tombetti E, Canti V, Sabbadini MG, Colombo G. Patients with breakthrough reactions to iodinated contrast media have low incidence of positive skin tests. Eur Ann Allergy Clin Immunol 2016; 48:137-144. [PMID: 27425169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The term "breakthrough reactions" designates repeated hypersensitivity reactions to iodinated contrast media (ICM) despite premedication with glucocorticoids and antihistamines. We aimed to retrospectively evaluate the rate of positive skin test (STs) in our cohort of patients with previous breakthrough reactions to different ICMs. METHODS A series of 35 patients, who experienced at least one breakthrough reaction to ICM and who underwent STs within 6 months from the reaction were studied, and results were compared to a control group of patients with a first hypersensitivity reaction occurred without premedication. Skin prick tests (SPT), intradermal tests (IDT) and patch tests (PT) at different dilutions, with a set of three to four ICM were performed. RESULTS Of the 35 patients with prior breakthrough reactions, 57% had an immediate reaction (IR) and 43% had a non-immediate reaction (NIR). Patients who experienced the first hypersensitivity IR or NIR, later had one or more breakthrough IR or NIR, respectively. Overall, 29% (10/35) of patients with prior breakthrough reactions resulted positive to STs compared to 57% (16/28) of the control group (p < 0.05). No significant difference in allergy history, age, sex, other clinical / demographic features nor chronic use of ACE-inhibitor, beta-blockers or NSAIDs was observed. CONCLUSION This preliminary finding suggests that patients with prior breakthrough reactions have significantly lower immunologically proven ICM reactions (positive STs) if compared to non-breakthrough patients. According to that, a considerable number of breakthrough reactions seems to be non-allergic hypersensitivity reactions or reactions which could be mostly prevented by a proper, well-timed skin testing. Larger prospective studies are needed to confirm these results, with a more careful analysis of patients' risk factors, a laboratory assessment that includes an in vitro allergy diagnostics, and hopefully a drug provocation test for selected cases.
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Affiliation(s)
- A Berti
- Vita-Salute San Raffaele University, Milan, Italy. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy. Phone: +39 02 264 340 78 Fax: +39 02 2634 103 E-mail:
| | - E Della-Torre
- Vita-Salute San Raffaele University, Milan, Italy. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mr Yacoub
- Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Tombetti
- Vita-Salute San Raffaele University, Milan, Italy. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - V Canti
- Vita-Salute San Raffaele University, Milan, Italy. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M G Sabbadini
- Vita-Salute San Raffaele University, Milan, Italy. Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G Colombo
- Department of Allergy and Clinical Immunology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Couto M, Silva D, Ferreira A, Cernadas JR. Intradermal Tests for Diagnosis of Drug Allergy are not Affected by a Topical Anesthetic Patch. Allergy Asthma Immunol Res 2014; 6:458-62. [PMID: 25229004 PMCID: PMC4161688 DOI: 10.4168/aair.2014.6.5.458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 05/24/2014] [Indexed: 01/13/2023]
Abstract
The use of topical anesthesia to perform intradermal tests (IDTs) for drug allergy diagnosis was never investigated. We aimed to determine the effects of a topical anesthetic patch containing prilocaine-lidocaine on wheal size of IDT with drugs. Patients who had positive IDT as part of their investigation process of suspected drug hypersensitivity were selected. IDT were performed according to guidelines. Anesthetic patch (AP) was placed and the same prior positive IDT, as well as positive histamine skin prick test (SPT) and negative (saline IDT) controls, were performed in the anesthetized area. Patients with negative IDT were also included to check for false positives with AP. Increase in wheals after 20 minutes both with and without AP was recorded and compared. 45 IDT were performed (36 patients), of which 37 have been previously positive (14 antibiotics, 10 general anesthetics, 6 non-steroidal anti-inflammatory drugs, 3 iodinated contrasts, 3 anti-Hi-histamines and 1 ranitidine). Mean histamine SPT size without the AP was 4.7 mm [95%CI (4.4-5.1]), and 4.6 mm [95%CI(4.2-5.0)] with anesthesia. Mean wheal increase in IDT for drugs without the anesthesia was 4.5 mm [95%CI(3.3-5.7)] and with anesthesia was 4.3 mm [95%CI(2.8-5.8)]. No statistical significant differences were observed between skin tests with or without AP for histamine SPT (P=0.089), IDT with saline (P=0.750), and IDT with drugs (P=0.995). None of the patients with negative IDT showed positivity with the AP, or vice-versa. The use of an AP containing prilocaine-lidocaine does not interfere with IDT to diagnose drug allergy, and no false positive tests were found.
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Affiliation(s)
- Mariana Couto
- Serviço de Imunoalergologia, Centro Hospitalar São João EPE, Porto, Portugal. ; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar São João EPE, Porto, Portugal. ; Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Portugal
| | - Ana Ferreira
- Serviço de Imunoalergologia, Centro Hospitalar São João EPE, Porto, Portugal
| | - Josefina R Cernadas
- Serviço de Imunoalergologia, Centro Hospitalar São João EPE, Porto, Portugal. ; Unidade de Imunoalergologia, Hospital Privado Boavista, Porto, Portugal
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