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Van Noord B, Samaan C, Flamm A. A Case of Delayed and Immediate Hypersensitivity Reactions Induced by Corticosteroids. Dermatitis 2024; 35:191-192. [PMID: 37471230 DOI: 10.1089/derm.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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de Magalhães AR, Machado GU, Lefèvre MA, Garreau AC, Nicolas JF, Vocanson M, Mosnier A, Pralong P, Nosbaum A. T cell-and non T cell-mediated delayed hypersensitivity to dupilumab. J Eur Acad Dermatol Venereol 2023; 37:e1180-e1182. [PMID: 37170927 DOI: 10.1111/jdv.19182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/05/2023] [Indexed: 05/13/2023]
Affiliation(s)
- A R de Magalhães
- Serviço de Dermatologia, Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil
- Serviço de Imunologia, Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil
| | - G U Machado
- Serviço de Imunologia, Universidade Federal da Bahia, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, Bahia, Brazil
| | - M A Lefèvre
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - A C Garreau
- Service d'Allergologie et Immunologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - J F Nicolas
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
- Service d'Allergologie et Immunologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - M Vocanson
- Service d'Allergologie et Immunologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Mosnier
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - P Pralong
- Department of Dermatology, Allergology and Photobiology, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France
| | - A Nosbaum
- CIRI, Centre International de Recherche en Infectiologie, Univ Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
- Service d'Allergologie et Immunologie Clinique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France
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O'Banion LAA, Shao MY, Ali A, Kochubey M, Yan Y, Fallentine J, Oh JH, Patel HR, Agrawal N, Carmona E, Hager ES, Kiguchi MM. Type IV Hypersensitivity Reaction after Cyanoacrylate Venous Closure. Ann Vasc Surg 2023; 95:218-223. [PMID: 37301253 DOI: 10.1016/j.avsg.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/30/2023] [Accepted: 06/03/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nonthermal endovenous closure techniques are routinely utilized to treat superficial axial venous reflux. Cyanoacrylate closure is a safe and effective modality implemented for truncal closure. However, an adverse reaction of type IV hypersensitivity (T4H), unique to cyanoacrylate, is a known risk. This study aims to evaluate the real-world incidence of T4H and examine risk factors that may predispose its development. METHODS A retrospective review between 2012- and 2022 was performed at four tertiary US institutions to examine patients who underwent cyanoacrylate vein closure of their saphenous veins. Patient demographics, comorbidities, CEAP (Clinical [C], Etiological [E], Anatomical [A], and Pathophysiological [P]) classification, and periprocedural outcomes were included. The primary endpoint was development of T4H post procedure. Logistic regression analysis for risk factors predictive of T4H was performed. Variables with a P-value of <0.05 were deemed significant. RESULTS 595 patients underwent 881 cyanoacrylate venous closures. Mean age was 66.2 ± 14.9, and 66% of patients were female. There were 92 (10.4%) T4H events in 79 (13%) patients. Oral steroids were administered to 23% for persistent and/or severe symptoms. There were no systemic allergic reactions to cyanoacrylate. Multivariate analysis revealed younger age (P = 0.015), active smoking status (P = 0.033), and CEAP 3 (P < 0.001) and 4 (P = 0.005) classifications as independent risk factors associated with development of T4H. CONCLUSIONS This real-world multicenter study shows the overall incidence of T4H to be 10%. CEAP 3 and 4 patients of younger age and smokers predicted a higher risk of T4H to cyanoacrylate.
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Affiliation(s)
- Leigh Ann A O'Banion
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA. Leighann.o'
| | - Michael Y Shao
- Division of Vascular Surgery, Northshore University Health System, Chicago, IL
| | - Amna Ali
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Mariya Kochubey
- Division of Vascular Surgery, Department of Surgery, University of California San Francisco-Fresno, Fresno, CA
| | - Yueqi Yan
- University of California Merced, Merced, CA
| | | | - Jae Hak Oh
- Georgetown University School of Medicine, Washington, DC
| | | | - Nishant Agrawal
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Emely Carmona
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Eric S Hager
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Misaki M Kiguchi
- Department of Vascular Surgery, MedStar Washington Hospital Center, Washington, DC
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Mosnier A, Vocanson M, Lefevre MA. Molecular profiling of skin test-induced inflammation to support the clinical diagnosis of delayed drug hypersensitivity reaction. Eur J Dermatol 2023; 33:64-66. [PMID: 37178043 DOI: 10.1684/ejd.2023.4438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Amandine Mosnier
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France
| | - Marc Vocanson
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France
| | - Marine-Alexia Lefevre
- CIRI, Centre International de Recherche en Infectiologie, (Team Epidermal Immunity and Allergy); INSERM, U1111; Univ Lyon; Université de Lyon 1; Ecole Normale Supérieure de Lyon; CNRS, UMR 5308, Lyon, France, Department of Dermatology and Allergology, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest-en-Jarez, France
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Abstract
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a rare but severe cutaneous drug hypersensitivity reaction. Delays in making a diagnosis of DRESS syndrome and lack of timely treatment may result in morbidity and mortality. However, the presentation can be misinterpreted as other pathologies because of a broad spectrum of clinical presentations, delayed reactions, and prolonged course. Despite the discontinuation of the medication that is the culprit, relapses of drug reactions frequently occur weeks to months later. Several drugs that are associated with DRESS syndrome are prescribed as psychotropic medications. This report describes the case of a patient with DRESS syndrome who was evaluated with the RegiSCAR scoring system as a "definite case," which was possibly induced by carbamazepine prescribed to treat bipolar I disorder. The young female patient was successfully treated with steroid medication after carbamazepine was discontinued. She was prescribed aripiprazole for mood stabilization without a subsequent recurrence of DRESS syndrome. We recommend that, in cases such as described here, clinicians take DRESS syndrome into consideration and provide proper timely management, particularly for patients receiving psychotropic drugs. A brief review of the literature concerning DRESS syndrome associated with psychotropic drugs and its pathogenesis are outlined and discussed.
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Zou W, Yang S, Chen L, Hu S, Hao G, Hu C. Iodixanol activation of mast cells: Implications in the pathogenesis of iodixanol-induced delayed cutaneous adverse reactions. Toxicology 2022; 465:153034. [PMID: 34774977 DOI: 10.1016/j.tox.2021.153034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/20/2022]
Abstract
Iodinated contrast media (ICM) is widely used in radiological examination and interventional therapy. In the commonly used ICM, iodixanol is considered to be the safer one. However, compared with other ICMs, it has a higher incidence of delayed cutaneous adverse reactions. The underlying mechanisms are unclear. In this study, mice with positive allergic reactions were selected based on the mouse clinical allergy symptom score and skin and blood samples taken 1, 6, 24, 48, and 72 h after ICMs (6 g iodine/kg) injection for histological and blood analyses. ICMs-induced pseudo-allergic reactions were investigated through in vivo intravital vascular imaging and passive cutaneous anaphylaxis (PCA) not mediated by IgE and through, calcium imaging degranulation of mast cells (MCs), and western blot assays in vitro. Results shows iodixanol-induced systemic anaphylaxis caused severe extravasation of plasma proteins and degranulation of skin MCs, and increased levels of plasma histamine, cytokines and inflammatory chemokines. Mechanistically, iodixanol increases degranulation of MCs and promotes the synthesis of inflammatory factors by activating PLC-γ and PI3K-related pathways. Trigonelline inhibit iodixanol-induced MC-related pseudo-allergic reactions in vitro and in vivo. These results suggest that mice in the iodixanol group had a higher incidence of delayed cutaneous reactions, characterized by cytokine release over time and delayed cutaneous MC degranulation. Iodixanol's delayed cutaneous adverse reactions may be due to a delayed phase of MC-related pseudo-allergic reactions. Trigonelline revealed anti-allergic activity in iodixanol-induced MC-related pseudo-allergic reactions.
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Affiliation(s)
- Weijie Zou
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Shuang Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Li Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Su Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Guangyu Hao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China; Institute of Medical Imaging of Soochow University, Suzhou, Jiangsu Province 215006, People's Republic of China.
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Saifuddin A, Koesnoe S, Kurniati N, Sirait S, Arisanty R, Yunihastuti E. COVID Arm After Moderna Booster in Healthcare Worker: A Case Report. Acta Med Indones 2021; 53:326-330. [PMID: 34611073] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
SARS CoV-2 virus has infected more than 200 million people worldwide and more than 4.4 million in Indonesia. The vaccination program has become one of the solutions launched by many countries globally, including Indonesia, to reduce the transmission rate of COVID-19. Various vaccination platforms are produced, such as inactivated, viral vector, mRNA, and protein subunit. The vaccination booster program with mRNA platform (Moderna) was launched by the Indonesian government to give better protection for health care workers, particularly from delta variant. In this case report, we discuss one of the typical side effects of Moderna vaccine, which is referred to as the COVID arm.
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Affiliation(s)
- Anshari Saifuddin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
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Abstract
Beta-lactam (BL) antibiotics are the most frequent cause of drug hypersensitivity in children, inducing both immediate and non-immediate reactions. Here we report a case of a 4-year-old child with a disseminated maculopapular exanthema 7 days after the first dose of amoxicillin-clavulanate, referred to our paediatric allergy department. Skin prick tests were negative. Intradermal tests were performed and, after 10 hours, indurated wheals larger than 10×10 mm with progressive erythema and disseminated maculopapular eruption were developed, related to amoxicillin and amoxicillin-clavulanate. Systemic reactions to BL skin tests are rarely reported and the majority are immediate reactions. This case illustrates a rare example of a non-immediate systemic reaction to intradermal tests, underlying the importance of skin testing before drug provocation tests in cases of moderate to severe non-immediate reactions.
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Affiliation(s)
- Joana Carvalho
- Pediatric Department, Local Health Unit of Matosinhos, EPE, Senhora da Hora, Portugal
| | - Georgeta Oliveira
- Pediatric Department, Local Health Unit of Matosinhos, EPE, Senhora da Hora, Portugal
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Kim J. A rare case of delayed hypersensitivity reaction to metal ions secondary to a remnant pedicle screw fragment after spinal arthrodesis. Acta Orthop Traumatol Turc 2020; 54:461-464. [PMID: 32554366 DOI: 10.5152/j.aott.2020.20148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delayed hypersensitivity reaction to metal ions is rare and has been mostly documented among patients undergoing total joint arthroplasty with metal-on-metal bearing surfaces. Nonetheless, to our knowledge, only a few cases associated with spinal arthrodesis have been reported in the literature. The aim of this case report was to describe the clinical features of a rare case of delayed-type hypersensitivity reaction to nickel that occurred after an extraordinarily long period of time (approximately 15 years) after spinal arthrodesis. Here, we present a 38-year-old patient who was referred to us with a diagnosis of delayed-type hypersensitivity reaction to nickel that was established by a skin patch test. The chief sign and symptoms of the patient were allergic contact dermatitis along with intractable, generalized itching that started several months ago. The medical history revealed that the patient had undergone spinal arthrodesis using rods and pedicle screws approximately 15 years ago, followed by revision surgery to remove the implants. Radiological examination showed a remnant pedicle screw fragment at the third lumbar vertebra that had broken off during the removal of implants nine years ago. However, the signs and symptoms of metal hypersensitivity started shortly before the patient was referred to our hospital. We decided to remove the screw fragment as allergic contact dermatitis was refractory to medical treatment. On postoperative day one, the itching was completely resolved, although the skin patch test remained positive.
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Affiliation(s)
- Jiha Kim
- Department of Neurosurgery, Kangwon National University, School of Medicine, Kangwon National University Hospital, Chuncheon-Si, Gangwon-Do, South Korea
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Pickwell K, Geerts M, van Moorsel D, Hilkman D, Kars M, Schaper NC. Regional differences in cell-mediated immunity in people with diabetic peripheral neuropathy. Diabet Med 2020; 37:350-355. [PMID: 31557355 PMCID: PMC7003874 DOI: 10.1111/dme.14143] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 12/19/2022]
Abstract
AIM To study cell-mediated immunity in the feet of people with type 2 diabetes with polyneuropathy. METHODS In a cohort comprising people with type 2 diabetes with polyneuropathy (n = 17) and without polyneuropathy (n = 12) and a healthy control group (n = 12) indurations due to delayed-type hypersensitivity responses to intracutaneous Candida albicans antigen were determined in the foot and compared with those in the arm (an area relatively spared in diabetic polyneuropathy). The sizes of indurations on the foot were correlated with electromyographic measurements in the participants with diabetes. RESULTS No differences were observed in the median size of indurations between the foot and arm in healthy controls and participants without polyneuropathy; in participants with polyneuropathy, induration sizes on the foot were smaller than on the arm: 0 (95% CI 0 to 1) vs 5 (95% CI 2 to 6) mm (P < 0.01). In participants with diabetes, larger indurations correlated with better nerve function (Spearman's rho 0.35 to 0.39). CONCLUSION Our findings suggest that diabetic peripheral polyneuropathy negatively affects cell-mediated immunity in the foot. (Clinical Trials registry no.: NCT01370837).
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Affiliation(s)
- K. Pickwell
- Department of Internal MedicineSubdivision of EndocrinologyMaastricht University Medical Centre
| | - M. Geerts
- Department of Internal MedicineSubdivision of EndocrinologyMaastricht University Medical Centre
| | - D. van Moorsel
- Department of Internal MedicineSubdivision of EndocrinologyMaastricht University Medical Centre
- Department of Human BiologyMaastricht UniversityMaastrichtThe Netherlands
| | - D. Hilkman
- Department of Clinical NeurophysiologyMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Kars
- Department of Internal MedicineSubdivision of EndocrinologyMaastricht University Medical Centre
| | - N. C. Schaper
- Department of Internal MedicineSubdivision of EndocrinologyMaastricht University Medical Centre
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Stone CA, Rukasin CR, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol 2019; 85:2694-2706. [PMID: 31472022 PMCID: PMC6955412 DOI: 10.1111/bcp.14112] [Citation(s) in RCA: 120] [Impact Index Per Article: 24.0] [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: 12/31/2018] [Revised: 07/26/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
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Affiliation(s)
- Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Christine R.F. Rukasin
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | | | - Elizabeth J. Phillips
- Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Vanderbilt University Medical SchoolNashvilleTennessee
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Miller RL, Shtessel M, Robinson LB, Banerji A. Advances in drug allergy, urticaria, angioedema, and anaphylaxis in 2018. J Allergy Clin Immunol 2019; 144:381-392. [PMID: 31247266 DOI: 10.1016/j.jaci.2019.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/11/2019] [Revised: 05/22/2019] [Accepted: 06/18/2019] [Indexed: 12/11/2022]
Abstract
Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
| | - Maria Shtessel
- Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Lacey B Robinson
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
| | - Aleena Banerji
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass
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14
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Mancuso G. Immediate and delayed contact hypersensitivity to thiocolchicoside. Acta Dermatovenerol Alp Pannonica Adriat 2018; 27:203-205. [PMID: 30564833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Thiocolchicoside is a muscle relaxant, anti-inflammatory, and analgesic. Administered orally, intramuscularly, or topically, this drug is used in the symptomatic treatment of muscular spasms and rheumatologic disorders. Despite its extensive use, thiocolchicoside is a very rare sensitizer. The case reported here is one of simultaneous contact urticaria and a delayed-type contact allergy to thiocolchicoside. The diagnosis was suggested by the patient's history and demonstrated by immediate and delayed positive skin test responses. The results of patch tests on intact skin (negative in immediate reading) and open tests (positive only on inflamed skin) may indicate that epicutaneously applied thiocolchicoside can induce an immediate reaction only when a damaged epidermal barrier is present. In contrast, skin integrity does not seem to prevent the appearance of a delayed-type reaction to this drug.
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15
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Wang Z, Qu L, Li M, Zhang J. Identification of hepatotoxic and nephrotoxic potential markers of triptolide in mice with delayed-type hypersensitivity. J Pharm Biomed Anal 2018; 160:404-414. [PMID: 30130725 DOI: 10.1016/j.jpba.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/29/2018] [Accepted: 08/08/2018] [Indexed: 02/06/2023]
Abstract
Triptolide (TP) is the crucial active ingredient of Tripterygium glycoside tablets and has been shown to have a significant therapeutic effect on delayed-type hypersensitivity (DTH)-related diseases. However, due to its potential hepatotoxicity and nephrotoxicity, adverse reactions have often been observed in long-term treatment regimens. Therefore, it is meaningful to find metabolic markers for toxicity for early diagnosis. In this study, a feasible strategy using HPLC-HRMS method combined with multivariate statistical analysis to discover toxic potential markers of TP was developed. TP was used to treat a DTH mouse model at a therapeutic dose (45μg/kg) and toxic dose (900 μg/kg). The metabolic profiles of the liver, kidney and plasma were characterized by HPLC-Q/TOF MS. Significant differences in the metabolite profiles of the liver, kidney and plasma existed between the toxic and therapeutically dosed mice. Forty-six metabolites were identified and 27 of them may be related to toxicity based on a structure-toxicity prediction model. Using OPLS-DA analysis, the metabolite profiles between the two dose groups could be well distinguished. It was found that 18, 4 and 4 metabolic markers were altered in the liver, kidney and plasma, respectively; 15, 4 and 3 of these metabolic markers were predicted to be toxic. Two toxic markers detected both in mouse plasma and human liver microsomes following incubation with TP showed great potential as early diagnosis markers for TP hepatotoxicity and nephrotoxicity.
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Affiliation(s)
- Zhe Wang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, PR China
| | - Liang Qu
- State Key Laboratory of Bioactive Substances and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, PR China
| | - Menglin Li
- State Key Laboratory of Bioactive Substances and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, PR China
| | - Jinlan Zhang
- State Key Laboratory of Bioactive Substances and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100050, PR China.
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Gao YY, Jiang Y, Chen GC, Li SS, Yang F, Ma Q. A Sensitive and Rapid UPLC-MS/MS Method for Determination of Monosaccharides and Anti-Allergic Effect of the Polysaccharides Extracted from Saposhnikoviae Radix. Molecules 2018; 23:molecules23081924. [PMID: 30071672 PMCID: PMC6222413 DOI: 10.3390/molecules23081924] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Allergic disease is a common clinical disease. Natural products provide an important source for a wide range of potential anti-allergic agents. This study was designed to evaluate the anti-allergic activities of the water-soluble polysaccharides extracted and purified from Saposhnikoviae Radix (SRPS). The composition and content of monosaccharides were determined to provide a material basis. Methods: An ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method was established to determine the composition and content of SRPS. 2,4-dinitrofluorobenzene (DNFB) induced a delayed-type hypersensitivity (DTH) mouse model orally administrated SRPS for seven consecutive days. Ear swelling, organ index, and serum IgE levels were observed to evaluate the anti-allergic activities. Results: The UPLC-MS/MS analysis showed that SRPS was consisted of eight monosaccharides including galacturonic acid, mannose, glucose, galactose, rhamnose, fucose, ribose, and arabinose with a relative molar ratio of 4.42%, 7.86%, 23.69%, 12.06%, 3.10%, 0.45%, 0.71%, and 47.70%, respectively. SRPS could effectively reduce ear swelling, a thymus index, and a serum IgE levels. Conclusions: The method was simple, rapid, sensitive, and reproducible, which could be used to analyze and determine the monosaccharide composition of SRPS. The vivo experiments demonstrated that SRPS may effectively inhibit development of DNFB-induced DTH. SRPS is a novel potential resource for natural anti-allergic drugs.
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Affiliation(s)
- Yan-Yan Gao
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Yue Jiang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Guo-Chao Chen
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Shuang-Shuang Li
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Fei Yang
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
| | - Qun Ma
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing 102488, China.
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Watts TJ. Severe delayed-type hypersensitivity to chloramphenicol with systemic reactivation during intradermal testing. Ann Allergy Asthma Immunol 2017; 118:644-645. [PMID: 28477797 DOI: 10.1016/j.anai.2017.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/05/2017] [Accepted: 03/09/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Timothy J Watts
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
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Wang S, Jin H, Tang Q, Fu J, Ren Z, Peng C, Shang L, Hao W, Wei X. The effect of ethephon on immune system in male offspring of mice. Environ Toxicol Pharmacol 2017; 49:119-123. [PMID: 27987403 DOI: 10.1016/j.etap.2016.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 06/06/2023]
Abstract
Ethephon can liberate ethylene which could interfere the plant growth process. The aim of the present study was to determine the effect of ethephon on developing immune system of male offspring. Ethephon could enhance NK cell activity in male mice. For 4-week-old male mice, lymphocytes of peripheral blood increased while the hemolytic plaque number decreased. Delayed type hypersensitivity(DTH) was inhibited in all groups. The expression of protein Bcl11b and p-p38 in thymus of treatment groups were lower than control group. Our results indicated that cellular immunity of male offspring is more sensitive to ethephon when exposed in pregnancy and lactation period. It should be emphasized that exposure to ethephon during the in utero stage and lactation stage still could damage the immune function of animal in the period before fully mature even in the dosage that could not influence the immune function of adult animal.
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Affiliation(s)
- Siqi Wang
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Haifeng Jin
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Qiuqiong Tang
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Jun Fu
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Zeming Ren
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Cike Peng
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Lanqin Shang
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Weidong Hao
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China
| | - Xuetao Wei
- Department of Toxicology, School of Public Health, Peking University, 100191, PR China; Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, Beijing 100191, PR China.
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Hermann R, Lam F, Spackman G. CAT of the Month (Critically Appraised Topics): True Allergic Reaction to Amide Local Anesthetics such as Lidocaine is Confirmed by Immunologic Testing (UT CAT# 3062). Tex Dent J 2016; 133:665. [PMID: 30549750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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20
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Pollock HW, Ebert CS, Dubin MG, White DR, Prazma J, Pillsbury HC. The Role of Soluble Interleukin-4 Receptor and Interleukin-5 Antibody in Preventing Late-Phase Allergy-Induced Eustachian Tube Dysfunction. Otolaryngol Head Neck Surg 2016; 127:169-76. [PMID: 12297806 DOI: 10.1067/mhn.2002.126901] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES: We investigated the role of soluble interleukin (IL)-4 receptors (sIL-4R) and IL-5 antibodies (IL-5Ab) in preventing allergic eustachian tube dysfunction (ETD) and middle ear effusion (MEE). STUDY DESIGN: Brown-Norway rats were sensitized to ovalbumin (OVA) and challenged transtympanically. Two groups of rats received either IL-4R or IL-5Ab transtympanically 1 hour before challenge. Three additional groups were used as controls. Following the second transtympanic challenge, the ventilatory and clearance functions of the eustachian tube (ET) were assessed at 0, 2, and 8 hours. Histology was prepared using cut paraffin sections stained with hematoxylin and eosin. RESULTS: sIL-4R-pretreated rats showed no significant changes in ventilatory or clearance functions of the ET or inflammatory changes in ET mucosa, whereas IL-5Ab pretreatment showed significant late ventilatory and clearance dysfunction as well as inflammatory mucosal changes. CONCLUSION: These data demonstrate that the late-phase allergic inflammatory response that leads to subsequent formation of ETD and MEE is prevented by pretreatment with sIL-4R and, more modestly, with IL-5Ab. Otitis media with effusion (OME) remains a significant problem in the pediatric population today. Despite advances in screening and treatment, the incidence has steadily risen over the past 20 years. It is now estimated that more than 80% of all children with have at least 1 episode of OME by age 3 and 40% will have 3 or more episodes. 1 Furthermore, earaches/ear infections represent the single greatest reason for a visit to the pediatrician after well-child visits. 2 Numerous studies have investigated the sequelae for children exposed to multiple episodes of OME, with conclusions ranging from no significant permanent deficits to impairments in receptive language skills, 1 balance and coordination, 3 and school readiness measures. 4 There remain several important controversies with regards to the pathogenesis and treatment of OME. One of these is the relationship between OME and allergy. A link between OME and allergy has existed for some time, 5 and one of the older empiric observations on the relationship between children with recurrent OME and allergy has resurfaced in recent years to explain the large number of patients with no other causative factor for fluid in the middle ear space. Bernstein 6 has demonstrated in a study of 100 patients with recurrent OME that almost a third can be attributed directly to allergy. Indeed, some consider this number a very conservative estimate. It is the intent of this study to examine the role of newer therapies such as antagonists to interleukin (IL)-4 and IL-5 for preventing the late-phase allergic reaction and their effect of preventing eustachian tube dysfunction and formation of middle ear effusion. IL−4 and −5 are 2 of a host of mediators that comprise the late-phase allergic response. Produced by a variety of cell types, their principal functions are to control subsequent cascades that are a response to antigenic challenge. Tissue inflammation, edema formation, mucus production, and eosinophilia are controlled by these cytokines. Our hypothesis is that administration of antagonists of both IL−4 and IL−5, in the form of sIL-4R and IL−5Ab, respectively, will result in a decreased allergic response to challenged tissue.
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Affiliation(s)
- Hoke W Pollock
- Department of Surgery, Division of Otolaryngology/HNS, University of North Carolina Hospitals, Chapel Hill 27599-7070, USA.
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21
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Vide J, Moreira C, Cunha AP, Baldaia H, Magina S, Azevedo F. Generalized Bullous Fixed Drug Eruption due to Bromhexine. Dermatol Online J 2016; 22:13030/qt7nt074w4. [PMID: 27617726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 06/06/2023] Open
Abstract
We describe a patient with a generalized bullous form of Fixed Drug Eruption (FDE) induced by bromhexine, a commonly used drug for respiratory symptoms. This is a rare association and generalized bullous FDE is also very rare. We emphasize the importance of patch tests in identifying the culprit drug.
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Affiliation(s)
- J Vide
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal.
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22
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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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Ye F, Hu Y, Yu W, Xie Z, Hu J, Cao Z, Li W, Wu Y. The Scorpion Toxin Analogue BmKTX-D33H as a Potential Kv1.3 Channel-Selective Immunomodulator for Autoimmune Diseases. Toxins (Basel) 2016; 8:115. [PMID: 27104568 PMCID: PMC4848641 DOI: 10.3390/toxins8040115] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 01/23/2023] Open
Abstract
The Kv1.3 channel-acting scorpion toxins usually adopt the conserved anti-parallel β-sheet domain as the binding interface, but it remains challenging to discover some highly selective Kv1.3 channel-acting toxins. In this work, we investigated the pharmacological profile of the Kv1.3 channel-acting BmKTX-D33H, a structural analogue of the BmKTX scorpion toxin. Interestingly, BmKTX-D33H, with its conserved anti-parallel β-sheet domain as a Kv1.3 channel-interacting interface, exhibited more than 1000-fold selectivity towards the Kv1.3 channel as compared to other K+ channels (including Kv1.1, Kv1.2, Kv1.7, Kv11.1, KCa2.2, KCa2.3, and KCa3.1). As expected, BmKTX-D33H was found to inhibit the cytokine production and proliferation of both Jurkat cells and human T cells in vitro. It also significantly improved the delayed-type hypersensitivity (DTH) responses, an autoreactive T cell-mediated inflammation in rats. Amino acid sequence alignment and structural analysis strongly suggest that the “evolutionary” Gly11 residue of BmKTX-D33H interacts with the turret domain of Kv1 channels; it appears to be a pivotal amino acid residue with regard to the selectivity of BmKTX-D33H towards the Kv1.3 channel (in comparison with the highly homologous scorpion toxins). Together, our data indicate that BmKTX-D33H is a Kv1.3 channel–specific blocker. Finally, the remarkable selectivity of BmKTX-D33H highlights the great potential of evolutionary-guided peptide drug design in future studies.
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Affiliation(s)
- Fang Ye
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Youtian Hu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Weiwei Yu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Zili Xie
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Jun Hu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Zhijian Cao
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Wenxin Li
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
| | - Yingliang Wu
- State Key Laboratory of Virology, College of Life Sciences, Wuhan University, Wuhan 430072, China.
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Colomer Gallardo A, Martínez Rodríguez R, Castillo Pacheco C, González Satue C, Ibarz Servio L. Dermatological side effects of intravesical Mitomycin C: Delayed hypersensitivity. ARCH ESP UROL 2016; 69:89-91. [PMID: 26959968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To know the dermatologic side effects of intravesical treatment with Mitomycin C in non muscle invasive bladder cancer. METHODS We describe two cases of palm and plantar dermatitis after such treatment. RESULT We describe two types of dermatitis pathogenesis during treatment with intravesical Mitomycin C: contact dermatitis and delayed hypersensitivity dermatitis. CONCLUSIONS Contact dermatitis of non-allergic origin is a common side effect described in many instances in the literature, on the other hand exists dermatitis secondary to delayed hypersensitivity type IV much less common, requiring treatment with corticosteroids.
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Affiliation(s)
- A Colomer Gallardo
- Servicio de Urología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. España
| | - R Martínez Rodríguez
- Servicio de Urología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. España
| | - C Castillo Pacheco
- Servicio de Urología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. España
| | - C González Satue
- Servicio de Urología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. España
| | - L Ibarz Servio
- Servicio de Urología. Hospital Universitari Germans Trias i Pujol. Universitat Autònoma de Barcelona. España
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25
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Onoprienko NN, Aronova NV, Pavlovich NV. [ROLE OF VARIOUS ANTIGENIC PREPARATIONS OF FRANCISELLA TULARENSIS IN FORMATION OF ALLERGY REACTION IN HUMANS AND ANIMALS]. Zh Mikrobiol Epidemiol Immunobiol 2016:22-29. [PMID: 27029112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIM Study the role of LPS in induction of anti-tularemia immunity in humans and animals. MATERIALS AND METHODS Activity of various antigenic preparations of tularemia microbe, including highly purified from protein and S- and R-LPS, was studied using leukocytolysis reaction with blood of vaccinated humans and guinea pigs and skin allergy test (guinea pigs). RESULTS Only the whole cells of Francisella tularensis, killed in protein non-denaturating conditions and conserving full S-LPS structure (tularin⁺) were shown to be inductors of delayed-type hypersensitivity reaction. Alterations in LPS structure (tularin⁻) results in a significant decrease, and denaturation of bacterial proteins (during boiling) results in a complete loss of immune stimulating properties of the preparations. Purified LPS preparations and O-polysaccharide fraction of S-LPS are not able to activate cell-mediated immunity. CONCLUSION The presence of LPS with the full structure affects the ability of antigenic preparations of F. tularensis to cause allergic reactions, and thus, form cell-mediated antitularemia immunity. LPS of F. tularensis can not be excluded as an adjuvant and provides the most effective presentation of epitopes of protein molecules for interaction with receptors of T-lymphocytes.
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MESH Headings
- Adjuvants, Immunologic/administration & dosage
- Adjuvants, Immunologic/chemistry
- Animals
- Antigens, Bacterial/administration & dosage
- Antigens, Bacterial/chemistry
- Antigens, Bacterial/immunology
- Bacterial Proteins/administration & dosage
- Bacterial Proteins/chemistry
- Bacterial Proteins/immunology
- Bacterial Vaccines/administration & dosage
- Bacterial Vaccines/chemistry
- Bacterial Vaccines/immunology
- Francisella tularensis/drug effects
- Francisella tularensis/immunology
- Francisella tularensis/pathogenicity
- Guinea Pigs
- Hot Temperature
- Humans
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/immunology
- Hypersensitivity, Delayed/microbiology
- Immunity, Cellular/drug effects
- Lipopolysaccharides/administration & dosage
- Lipopolysaccharides/chemistry
- Lipopolysaccharides/immunology
- Skin Tests
- Survival Analysis
- T-Lymphocytes/drug effects
- T-Lymphocytes/immunology
- T-Lymphocytes/microbiology
- Tularemia/immunology
- Tularemia/microbiology
- Tularemia/mortality
- Tularemia/prevention & control
- Vaccination
- Vaccines, Live, Unattenuated
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Dias de Castro E, Leblanc A, Sarmento A, Cernadas JR. An unusual case of delayed-type hypersensitivity to ceftriaxone and meropenem. Eur Ann Allergy Clin Immunol 2015; 47:225-227. [PMID: 26549341] [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: 06/05/2023]
Abstract
Recent studies have demonstrated a low cross-reactivity between β-lactam antibiotics and carbapenems in IgE-mediated reactions. There are no studies on cross-reactivity of meropenem in patients with non-immediate hypersensitivity to cephalosporins. We describe a case of a 13-year-old male, admitted in Neurosurgery with a severe extradural empyema complicating frontal sinusitis, submitted to an emergent bifrontal craniotomy. A generalized maculopapular exanthema, fever and malaise, appeared by the 7th day of meningeal doses of ceftriaxone, clindamycin and vancomycin. Those were replaced by meropenem, with posterior worsening of the reaction and mucosal involvement. A new scheme with amikacin, metronidazole and linezolid was done with improvement. Skin prick, intradermal and patch tests to penicillins, ceftriaxone and meropenem were negative. Lymphocyte transformation test was positive to ceftriaxone and negative to meropenem.Non-immediate T cell mechanism seems to be involved. Diagnosis work-up couldn't exclude cross-reactivity between ceftriaxone and meropenem.
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Affiliation(s)
- E Dias de Castro
- Allergy and Immunology Division, Hospital S. João, E.P.E., Porto, Portugal. Serviço de Imunoalergologia Hospital S. João Alameda Prof. Hernâni Monteiro 4200-319 Porto, Portugal. E-mail:
| | - A Leblanc
- Allergy and Immunology Division, Hospital S. João, E.P.E., Porto, Portugal
| | - A Sarmento
- Infecciology Division, Hospital S. João, E.P.E., Porto, Portugal
| | - J R Cernadas
- Allergy and Immunology Division, Hospital S. João, E.P.E., Porto, Portugal
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Hacard F, Bérard F. [DRUGS DESENSITIZATION]. Rev Prat 2015; 65:986-989. [PMID: 26619741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We now have the means to give a patient the drug he absolutely needs even if these have been responsible for immediate or delayed hypersensitivity reactions. We use so-called "desensitization protocols" which rely on strong experimental pathophysiological bases. We take as examples immediate hypersensitivity to aspirin/NSAID and chemotherapy and non-severe delayed hypersensitivity to antibiotic for which tolerance induction gives excellent results.
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Bensaïd B, Valeyrie-Allanore L, Lebrun-Vignes B, Nicolas JF. [DRUG INDUCED EXANTHEMA AND SEVERE CUTANEOUS DRUG REACTIONS]. Rev Prat 2015; 65:981-985. [PMID: 26619740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cutaneous adverse drug reactions (CADR) are delayed hypersensivities. Their clinical presentation and severity are very diverse ranging from the frequent and benign exanthemas to the rare but severe CADR involving deep organs in the case of drug reaction with eosinophilia and systemic symptoms (DRESS) or leading to skin bulla and epidermal detachment in toxic epidermal necrolysis. The main differential diagnoses are infections, especially viral ones, which could give clinical symptoms identical to those occurring in CADR.
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Nizhenkovska IV, Pidchenko VT, Bychkova NG, Bisko NA, Rodnichenko AY, Kozyko NO. Influence of Ganoderma lucidum (Curt.: Fr.) P. Karst. on T-cell-mediated immunity in normal and immunosuppressed mice line CBA/Ca. Ceska Slov Farm 2015; 64:139-143. [PMID: 26459128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The article presents the results of the investigation of the effect of biomass powder of the fungus Ganoderma lucidum on T-cell-mediated immunity in normal and immunosuppressed mice CBA/Ca. Delayed-type hypersensitivity assay was used. Experimental immunodeficiency was established with intraperitoneal injection of the immunosuppressant cyclophosphamide at a single dose of 150 mg/kg on the first day of the experiment. Results of the study show that the administration of biomass powder of Ganoderma lucidum in a dose of 0.5 mg/kg orally for 10 days increases the delayed-type hypersensitivity response in normal mice CBA/Ca. Administration of 0.5 mg/kg of biomass powder of the fungus Ganoderma lucidum for 10 days blocked the development of the T-cell-mediated immunosuppression, induced by administration of cyclophosphamide and restored the delayed-type hypersensitivity response in immunosuppressed mice. Key words: fungus Ganoderma lucidum cyclophosphamide immunodeficiency T-cell-mediated immunity delayed-type hypersensitivity.
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Bentley P. Author response. Neurology 2015; 85:204. [PMID: 26378292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
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Stejskal V, Reynolds T, Bjørklund G. Increased frequency of delayed type hypersensitivity to metals in patients with connective tissue disease. J Trace Elem Med Biol 2015; 31:230-6. [PMID: 25636536 DOI: 10.1016/j.jtemb.2015.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/05/2015] [Accepted: 01/06/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Connective tissue disease (CTD) is a group of inflammatory disorders of unknown aetiology. Patients with CTD often report hypersensitivity to nickel. We examined the frequency of delayed type hypersensitivity (DTH) (Type IV allergy) to metals in patients with CTD. METHODS Thirty-eight patients; 9 with systemic lupus erythematosus (SLE), 16 with rheumatoid arthritis (RA), and 13 with Sjögren's syndrome (SS) and a control group of 43 healthy age- and sex-matched subjects were included in the study. A detailed metal exposure history was collected by questionnaire. Metal hypersensitivity was evaluated using the optimised lymphocyte transformation test LTT-MELISA(®) (Memory Lymphocyte Immuno Stimulation Assay). RESULTS In all subjects, the main source of metal exposure was dental metal restorations. The majority of patients (87%) had a positive lymphocyte reaction to at least one metal and 63% reacted to two or more metals tested. Within the control group, 43% of healthy subjects reacted to one metal and only 18% reacted to two or more metals. The increased metal reactivity in the patient group compared with the control group was statistically significant (P<0.0001). The most frequent allergens were nickel, mercury, gold and palladium. CONCLUSIONS Patients with SLE, RA and SS have an increased frequency of metal DTH. Metals such as nickel, mercury and gold are present in dental restorative materials, and many adults are therefore continually exposed to metal ions through corrosion of dental alloys. Metal-related DTH will cause inflammation. Since inflammation is a key process in CTDs, it is possible that metal-specific T cell reactivity is an etiological factor in their development. The role of metal-specific lymphocytes in autoimmunity remains an exciting challenge for future studies.
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Affiliation(s)
- Vera Stejskal
- Wenner-Gren Institute for Experimental Biology, University of Stockholm, Stockholm, Sweden.
| | - Tim Reynolds
- Chemical Pathology, Burton Hospitals NHS Foundation Trust, Burton upon Trent, United Kingdom
| | - Geir Bjørklund
- Council for Nutritional and Environmental Medicine, Mo i Rana, Norway
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Kim JT, Jeong HW, Choi KH, Yoon TY, Sung N, Choi YK, Kim EH, Chae HB. Delayed hypersensitivity reaction resulting in maculopapular-type eruption due to entecavir in the treatment of chronic hepatitis B. World J Gastroenterol 2014; 20:15931-15936. [PMID: 25400481 PMCID: PMC4229562 DOI: 10.3748/wjg.v20.i42.15931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/25/2014] [Accepted: 07/25/2014] [Indexed: 02/07/2023] Open
Abstract
Several clinical trials have demonstrated the potent antiviral efficacy of entecavir (ETV), and this relatively new nucleoside analogue drug has rapidly become a frequently prescribed therapy for chronic hepatitis B (CHB) worldwide. While the studies have also shown a good overall safety profile for ETV, adverse drug reactions (ADRs) in patients with advanced cirrhosis have been reported and represent a broad spectrum of drug-induced injuries, including lactic acidosis, myalgia, neuropathy, azotemia, hypophosphatemia, muscular weakness, and pancreatitis, as well as immune-mediated responses (i.e., allergic reactions). Cutaneous ADRs associated with ETV are very rare, with only two case reports in the publicly available literature; both of these cases were classified as unspecified hypersensitivity allergic (type I) ADR, but neither were reported as pathologically proven or as evaluated by cytokine release analysis. Here, we report the case of a 45-year-old woman who presented with a generalized maculopapular rash after one week of ETV treatment for lamivudine-resistant CHB. The patient reported having experienced a similar skin eruption during a previous three-month regimen of ETV, for which she had self-discontinued the medication. Histopathological analysis of a skin biopsy showed acanthotic epidermis with focal parakeratosis and a perivascular lymphocytic infiltrate admixed with interstitial eosinophils in the papillary and reticular dermis, consistent with a diagnosis of drug sensitivity. A lymphocyte stimulation test showed significantly enhanced IL-4, indicating a classification of type IVb delayed hypersensitivity. The patient was switched to an adefovir-lamivudine combination regimen and the skin eruption resolved two weeks after the ETV withdrawal. This case represents the first pathologically and immunologically evidenced ETV-induced delayed type hypersensitivity skin reaction reported to date. Physicians should be aware of the potential, although rare, for cutaneous ADRs associated with ETV treatment.
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MESH Headings
- Antiviral Agents/adverse effects
- Biopsy
- Cells, Cultured
- Cytokines/metabolism
- Drug Eruptions/blood
- Drug Eruptions/diagnosis
- Drug Eruptions/etiology
- Drug Eruptions/immunology
- Drug Substitution
- Female
- Guanine/adverse effects
- Guanine/analogs & derivatives
- Hepatitis B, Chronic/diagnosis
- Hepatitis B, Chronic/drug therapy
- Humans
- Hypersensitivity, Delayed/blood
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/diagnosis
- Hypersensitivity, Delayed/immunology
- Leukocytes, Mononuclear/drug effects
- Leukocytes, Mononuclear/immunology
- Leukocytes, Mononuclear/metabolism
- Middle Aged
- Skin/drug effects
- Skin/immunology
- Skin/pathology
- Time Factors
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Bergmann MM, Villard J, Caubet JC. [Genetic predispositions in drug allergy: the role of HLA]. Rev Med Suisse 2014; 10:864-868. [PMID: 24834645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The pathophysiology of drug allergy is complex and relies on the interaction between the drug and the immune system in combination with environmental factors, in particular viruses. Genetic predisposition plays an important role in drug allergy. Recent publications have shown the importance of HLA genes, particularly in the delayed hypersensitivity reactions. In fact, particular HLA alleles were identified as risk factors in the development of severe allergic reactions to certain drugs, identifying people at risk of hypersensitivity before initiation of specific treatment. In the future, identification of other alleles in HLA genes will improve patients care by preventing hypersensitivity reactions associated with significant morbidity and mortality.
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Roessler PP, Witt F, Efe T, Schmitt J. Arthroprosthetic cobaltism and pseudotumour also occur in patients with small diameter femoral ball head metal-on-metal total hip arthroplasties. BMJ Case Rep 2014; 2014:bcr-2013-203362. [PMID: 24682139 DOI: 10.1136/bcr-2013-203362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Metal-on-metal implants have been widely discredited in public during the past few months. At the same time patients' awareness has risen leading to an increased number of consultations regarding the topic. As hip resurfacings and total hip arthroplasties with large diameter femoral ball heads are already known for excessive metal wear, even small diameter ball heads with low friction get into focus now. We report a case of a 75-year-old man with recurrent hip pain almost 14 years after low friction metal-on-metal total hip arthroplasty. In addition to elevated serum cobalt levels, a type IV sensitivity reaction to cobalt could be noted. Explantation of a highly worn small diameter femoral ball head as well as development of the so-called pseudotumour indicate that all patients should be screened for signs of metal wear regardless of their specific risk factors or the type of metal-on-metal implant.
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Affiliation(s)
- Philip P Roessler
- Department of Orthopedics & Rheumatology, University Hospital Marburg, Marburg, Germany
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36
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Khakhariya R, Rathod SP, Gandhi H, Variya B, Trivedi J, Bhamre P, Rajput SJ. Carboplatin-induced Fanconi-like syndrome in rats: amelioration by pentoxifylline. Environ Toxicol Pharmacol 2014; 37:185-194. [PMID: 24361643 DOI: 10.1016/j.etap.2013.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Carboplatin is a congener of cisplatin used in the treatment of ovarian, head and neck and small-cell lung cancer. However, the clinical efficacy of carboplatin is marred by the development of ROS-dependent nephrotoxicity. The pathophysiological damage inflicted upon the kidney by carboplatin closely resembles to that of Fanconi syndrome. AIMS AND OBJECTIVES The present study aimed at inducing Fanconi-like syndrome in rats by administration of carboplatin. Objectives of the study involved evaluation of biochemical parameters coherent to Fanconi-like syndrome. Further, an attempt was made to evaluate the potential therapeutic effect of pentoxifylline in this condition. RESULTS The results of the study demonstrated that the urinary excretion profile of carboplatin treated rats closely resembled to that of patients suffering from Fanconi-like condition. Pentoxifylline was able to ameliorate this nephrotoxic condition as suggested by the change in levels of membrane bound ATPases, MDA and GSH. The urinary levels of tyrosine and cysteine correlate well with that of Fanconi-like condition in animals and humans. CONCLUSION In lieu of these observations, our study suggested that carboplatin-induced renovascular damage resembles to Fanconi-like condition which can be mitigated by pentoxifylline.
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Affiliation(s)
- Ravi Khakhariya
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - S P Rathod
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Hardik Gandhi
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India.
| | - Bhavesh Variya
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Jinal Trivedi
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Prachi Bhamre
- Pharmaceutical Quality Assurance Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - S J Rajput
- Pharmaceutical Quality Assurance Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
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37
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Perez SA, Anastasopoulou EA, Tzonis P, Gouttefangeas C, Kalbacher H, Papamichail M, Baxevanis CN. AE37 peptide vaccination in prostate cancer: a 4-year immunological assessment updates on a phase I trial. Cancer Immunol Immunother 2013; 62:1599-608. [PMID: 23934022 PMCID: PMC11029046 DOI: 10.1007/s00262-013-1461-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/26/2013] [Indexed: 01/24/2023]
Abstract
In our recent phase I trial, we demonstrated that the AE37 vaccine is safe and induces HER-2/neu-specific immunity in a heterogeneous population of HER-2/neu (+) prostate cancer patients. Herein, we tested whether one AE37 boost can induce long-lasting immunological memory in these patients. Twenty-three patients from the phase I study received one AE37 boost 6-month post-primary vaccinations. Local/systemic toxicities were evaluated following the booster injection. Immunological responses were monitored 1-month (long-term booster; LTB) and 3-year (long-term immunity; LTI) post-booster by delayed-type hypersensitivity, IFN-γ ELISPOT and proliferation assays. Regulatory T cell (Treg) frequencies, plasma transforming growth factor-β (TGF-β) and indoleamine 2,3-deoxygenase (IDO) activity levels were also determined at the same time points. The AE37 booster was safe and well tolerated. Immunological monitoring revealed vaccine-specific long-term immunity in most of the evaluated patients during both LTB and LTI, although individual levels of immunity during LTI were decreased compared with those measured 3 years earlier during LTB. This was paralleled with increased Tregs, TGF-β levels and IDO activity. One AE37 booster generated long-term immunological memory in HER-2/neu (+) prostate cancer patients, which was detectable 3 years later, albeit with a tendency to decline. Boosted patients had favorable clinical outcome in terms of overall and/or metastasis-free survival compared with historical groups with similar clinical characteristics at diagnosis. We suggest that more boosters and/or concomitant disarming of suppressor circuits may be necessary to sustain immunological memory, and therefore, further studies to optimize the AE37 booster schedule are warranted.
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Affiliation(s)
- Sonia A Perez
- Cancer Immunology and Immunotherapy Center, Saint Savas Cancer Hospital, Building No. 2, 3rd Floor, 171 Alexandras Avenue, 11522, Athens, Greece,
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38
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Maniu CM, Buss G, Feldmeyer L, Spertini F, Ribi C. [Severe delayed drug hypersensitivity reactions]. Rev Med Suisse 2013; 9:803-811. [PMID: 23667969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although most delayed drug hypersensitivity reactions are mild and show rapid improvement after drug discontinuation, there are severe systemic and/or cutaneous drug reactions which may be life-threatening. These entities are discussed here, namely DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms), acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). Early detection of warning signs and symptoms may help to take appropriate measures precociously.
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Barouti N, Masouyé I, Boehncke WH, Prins C. [Heparins and skin reactions: from diagnostic to management]. Rev Med Suisse 2013; 9:705-711. [PMID: 23621039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The use of heparins in the prophylaxis and treatment of thromboembolic diseases shows non-negligible risks of cutaneous lesions, which are very frequently underestimated by physicians. As this risk often originates from either delayed-type hypersensitivity reactions or life-threatening heparin-induced thrombocytopenia, a quick diagnosis and an adapted management are thus crucial. Furthermore, as most cases are emergencies, allergologic testing cannot be considered in the first place. In this context, an overview of the therapeutic as well as management recommendations is presented, taking into account the most recent treatments.
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Affiliation(s)
- Neda Barouti
- Service de dermatologie et vénéréologie, Département des spécialités de médecine, HUG, 1211 Genève 14
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Liu Y, Yang T, Li H, Li MH, Liu J, Wang YT, Yang SX, Zheng J, Luo XY, Lai Y, Yang P, Li LM, Zou Q. BD750, a benzothiazole derivative, inhibits T cell proliferation by affecting the JAK3/STAT5 signalling pathway. Br J Pharmacol 2013; 168:632-43. [PMID: 22906008 PMCID: PMC3579284 DOI: 10.1111/j.1476-5381.2012.02172.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 07/21/2012] [Accepted: 08/10/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE A series of benzothiazole derivatives were screened for immunosuppressive activity; of these compounds BD750 was found to be the most effective immunosuppressant. The purpose of the current study was to determine the immunosuppressive activity of BD750 on T cell proliferation and its potential mode of action. EXPERIMENTAL APPROACH T cell proliferation, CD25 and CD69 expression and cell cycle distribution were measured in vitro by flow cytometry. Cell viability was determined by CCK-8 assay. Cytokine levels were measured by elisa. The activation of signal-regulated molecules was assessed by Western blot analysis. The effects of BD750 were evaluated in vivo in a mouse model of delayed-type hypersensitivity. KEY RESULTS BD750 significantly inhibited mouse and human T cell proliferation, stimulated either by anti-CD3/anti-CD28 monoclonal antibodies or by an alloantigen, in a dose-dependent manner in vitro. No obvious cytotoxic effects of BD750 were observed in our experimental conditions. Furthermore, BD750 did not inhibit CD25 and CD69 expression or IL-2 and IL-4 secretion, but induced cell cycle arrest at the G(0) /G(1) phase in activated T cells. In IL-2-stimulated CTLL-2 cells and primary activated T cells, BD750 inhibited cell proliferation and STAT5 phosphorylation, but not Akt or p70S6K phosphorylation. BD750 also reduced the T cell-mediated delayed-type hypersensitivity response in mice in a dose-dependent manner. CONCLUSION AND IMPLICATIONS These data indicate that BD750 inhibits IL-2-induced JAK3/STAT5-dependent T cell proliferation. BD750 has the potential to be used as a lead compound for the design and development of new immunosuppressants for preventing graft rejection and treating autoimmune diseases.
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Affiliation(s)
- Y Liu
- Department of Immunology, School of Basic Medical Sciences, Chengdu Medical College, Chengdu, Sichuan, China
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Ligacheva AA, Ivanova AN, Belsky YP, Belska NV, Trofimova ES, Danilets MG, Dygai AM. Effect of NF-κB inhibitor aurothiomalate on local inflammation in experimental Th1- and Th2-type immune response. Bull Exp Biol Med 2013; 153:472-4. [PMID: 22977847 DOI: 10.1007/s10517-012-1743-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We compared the effect of NF-κB inhibitor aurothiomalate and voltaren on local inflammation in different types of immune response. Both substances reduced edema caused by sheep erythrocytes (Th1-type immune response) and local immediate-type hypersensitivity response induced with ovalbumin (Th2-dependent response). The anti-inflammatory effects of aurothiomalate were similar to those of voltaren during Th1-type immune response.
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Affiliation(s)
- A A Ligacheva
- Institute of Pharmacology, Siberian Division of the Russian Academy of Medical Sciences, Tomsk, Russia.
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Bumbăcea RS, Petruţescu B, Bumbăcea D, Strâmbu I. Immediate and delayed hypersensitivity reactions to intravascular iodine based radiocontrast media -- an update. Pneumologia 2013; 62:47-51. [PMID: 23781574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Used since 1929 in medical practice, nowadays four chemical varieties of intravascular iodine based radiocontrast media (I-RCM) are available: ionic monomers with high osmolarity, ionic dimers with low osmolarity, non-ionic monomers with low osmolarity and non-ionic iso-osmolar dimers. Increasing prescription of l-RCMs augments the number of reported hypersensitivity reactions. I-RCM induced hypersensitivity reactions can be dclasified in two types: immediate hypersensitivity reactions (IHRs - occurring within the first hour) and delayed hypersensitivity reactions (DHRs - occurring between 1 hour and 7 days). IHRs usually present as urticaria and angioedema but may associate severe respiratory and cardiovascular symptoms. Risk factors for an IHRs include a prior immediate reaction, personal history of atopic diseases (mainly asthma) and treatment with beta blocking agents. Diagnostic tests for IHRs include blood tests (serum tryptase) and skin tests (prick and intradermal) performed 2 to 6 months after IHR. High osmolarity of the I-RCM is the factor most strongly associated with IHRs. Primary prevention of IHRs involves the use of non-ionic low-osmolar or iso-osmolar agents for all intravascular procedures. DHRs are usually mild to moderate in severity, transient and self-limiting, presenting as maculopapular rash in more than 50% of cases. As with IHRs, the most important risk factor for DHRs is a previous reaction to I-RCM. Assessment of DHRs includes skin prick tests, intradermal and patch tests. Due to extensive cross-reactivity between I-RCM, a change of product is no guarantee against a repeated reaction. Current premedication procedures in patients with previous severe reactions can reduce symptoms, but may not prevent recurrent reactions.
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Abstract
Heparins are widely used for prophylaxis and treatment of thromboembolic diseases. Besides bleeding complications, heparin-induced skin lesions are the most frequent unwanted adverse effects of subcutaneous heparin treatment. Evidence suggests that these lesions are more common than previously thought. Lesions are most frequently due to either allergic reactions or to possibly life-threatening heparin-induced thrombocytopenia. Early recognition and adequate treatment are highly important, because although both complications initially show a similar clinical picture, their treatment should be fundamentally different. Furthermore, risk factors associated with the patient, drug, and treatment regimen have been identified. We review the clinical range of heparin-induced skin lesions, emphasise evidence and controversies in epidemiology, diagnosis, and differential diagnosis, and discuss the management of patients with these skin lesions.
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Affiliation(s)
- Marc Schindewolf
- Division of Vascular Medicine and Haemostaseology, Department of Internal Medicine, Hospital of the Johann Wolfgang Goethe University, Frankfurt am Main, Germany
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Tripathi SM, Thaker AM, Joshi CG, Sankhala LN. Acephate immunotoxicity in White Leghorn cockerel chicks upon experimental exposure. Environ Toxicol Pharmacol 2012; 34:192-199. [PMID: 22554862 DOI: 10.1016/j.etap.2012.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 01/19/2012] [Accepted: 04/03/2012] [Indexed: 05/31/2023]
Abstract
Immunotoxicity for subacute exposure to acephate (O,S-dimethyl-acetylphosphoramidothioate) was assessed in day old White Leghorn (WLH) cockerel chicks. The chicks were divided into five groups. Groups C1 and C2 served as plain control and vehicle control respectively. Chicks of groups T1, T2 and T3 were administered acephate suspended in groundnut oil at 21.3mg/kg, 28.4mg/kg and 42.6mg/kg respectively orally for 28 days. A non-significant reduction in total leukocyte count was observed. Although, anti-Newcastle Disease Virus (NDV) antibody titer, serum total protein (TP), serum globulin, serum albumin and organ:body weight ratios of immune organs were significantly suppressed. The delayed type hypersensitivity response to 2,4-dinitro-1-chlorobenzene (DNCB) was not significantly altered. Histopathologically, bursa and spleen showed mild depletion of lymphocytes. Furthermore, DNA fragmentation assay was performed and detected ladder pattern (180bp) in DNA. It was concluded that subacute acephate exposure at low concentrations may affect immune responses in avian species.
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Affiliation(s)
- Syamantak Mani Tripathi
- Department of Pharmacology & Toxicology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand 388001, Gujarat, India.
| | - A M Thaker
- Department of Pharmacology & Toxicology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand 388001, Gujarat, India.
| | - C G Joshi
- Department of Animal Biotechnology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand 388001, Gujarat, India
| | - Laxmi Narayan Sankhala
- Department of Pharmacology & Toxicology, College of Veterinary Science and Animal Husbandry, Anand Agricultural University, Anand 388001, Gujarat, India.
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45
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Ally MR, Betteridge JD, Veerappan GR. Delayed hypersensitivity reaction with infliximab: unusual to occur after initial dose. Inflamm Bowel Dis 2012; 18:E1592-3. [PMID: 22231796 DOI: 10.1002/ibd.21909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/01/2011] [Indexed: 01/06/2023]
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46
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Zhang XD, Xu DZ, Li JH, Wang T, Ge FH, Yang L. [Study on the immunocompetence of polysaccharide extracted from root of Salvia miltiorrhiza]. Zhong Yao Cai 2012; 35:949-952. [PMID: 23236833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study the immune activity of polysaccharide extracted from root of Salvia miltiorrhiza. METHODS Investigated the effects of polysaccharide extracted from root of Salvia miltiorrhiza on lymphocyte proliferation response of mouse induced by LPS (the lipopolysaccharide LPS), phagocytosis of the peritoneal macrophage of mice to chick erythrocytes and the mouse models of delayed type hypersensitivity (DTH) response induced by DNFB. RESULTS Lymphocyte proliferation and phagocytosis of the peritoneal macrophage of mice could be promoted by the polysaccharide, which could inhibit ear edema and capillary permeability increase induced by DNFB and enlarged the thymus and splenic index in mice. The expression of iNOS, IFN-alpha and IL-1beta was inhibited significantly in the treatment group. CONCLUSION The polysaccharide extracted from Salvia miltiorrhiza can improve immune function.
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Affiliation(s)
- Xiang-Dong Zhang
- Guangzhou Hanfang Pharmaceutical Company Limited/National Engineer Research Center for Modernization of Extraction and Separation of Traditional Chinese Medicine (TCM), Guangzhou 510240, China.
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Ghule BV, Yeole PG. In vitro and in vivo immunomodulatory activities of iridoids fraction from Barleria prionitis Linn. J Ethnopharmacol 2012; 141:424-431. [PMID: 22440262 DOI: 10.1016/j.jep.2012.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2011] [Revised: 12/08/2011] [Accepted: 03/03/2012] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Barleria prionitis Linn. (Family: Acanthaceae), one of the important Ayurvedic medicinal plant in India, has long been used to treat variety of ailments including swellings, gout, arthritic and rheumatic disorders, nervine and skin diseases, and also acts as immunorestorative. AIM OF THE STUDY The present study was aimed to explore in vitro and in vivo immunomodulatory activities of the iridoids fraction i.e. n-butanol fraction of methanol extract from Barleria prionitis aerial parts (IFBp). MATERIALS AND METHODS IFBp was studied for in vitro [nitroblue tetrazolium (NBT) test and neutrophils candidacidal assay] and in vivo immunomodulatory activity on cellular and humoral immune responses to the antigenic challenge by sheep red blood cells (SRBCs) and by neutrophil adhesion test, phagocytic activity and cyclophosphamide-induced myelosuppression. The study comprised the preliminary phytochemical screening, HPTLC standardization and maximum tolerable dose determination of IFBp. RESULTS IFBp (50, 100 and 200μg/ml) significantly (P≤0.01) increased the intracellular killing activity of stimulated neutrophils assayed by in vitro NBT reduction test and neutrophils candidacidal assay. Pretreatment of IFBp (100 and 200mg/kg; p.o.) evoked a significant increase in percent neutrophils and neutrophils adhesion to nylon fibres. Oral administration of IFBp augmented the humoral immune response to SRBCs, evidenced by increase in antibody titres and dose dependently potentiated the delayed-type hypersensitivity reaction induced by SRBCs in mice. IFBp potentiated significantly (P≤0.01) the macrophage phagocytic activity and ameliorated the red blood cells, total white blood cells and platelets count and haemoglobin concentration, and also restored the myelosuppressive effects induced by cyclophosphamide. The content (% w/w; mean±SD, n=3) of main iridoids i.e. shanzhiside methyl ester and barlerin was found to be 21.55±2.40 and 10.03±1.69 in IFBp of BP, respectively. CONCLUSION The present investigation reveals that IFBp is a potent immunostimulant, stimulating both the specific and non-specific immune mechanisms.
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MESH Headings
- 1-Butanol/chemistry
- Acanthaceae/chemistry
- Adjuvants, Immunologic/isolation & purification
- Adjuvants, Immunologic/pharmacology
- Adjuvants, Immunologic/toxicity
- Animals
- Bone Marrow Diseases/chemically induced
- Bone Marrow Diseases/drug therapy
- Bone Marrow Diseases/immunology
- Candida albicans/pathogenicity
- Cell Adhesion/drug effects
- Cyclophosphamide
- Disease Models, Animal
- Erythrocytes/drug effects
- Erythrocytes/immunology
- Hemagglutination/drug effects
- Hemagglutination Tests
- Humans
- Hypersensitivity, Delayed/chemically induced
- Hypersensitivity, Delayed/immunology
- Immunity, Cellular/drug effects
- Immunity, Humoral/drug effects
- Iridoids/isolation & purification
- Iridoids/pharmacology
- Iridoids/toxicity
- Male
- Maximum Tolerated Dose
- Methanol/chemistry
- Mice
- Neutrophil Activation/drug effects
- Neutrophils/drug effects
- Neutrophils/immunology
- Neutrophils/microbiology
- Phagocytosis/drug effects
- Phytotherapy
- Plant Components, Aerial
- Plants, Medicinal
- Sheep
- Solvents/chemistry
- Time Factors
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Affiliation(s)
- B V Ghule
- Institute of Pharmaceutical Education and Research, Wardha 442 001, Maharashtra State, India
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Hjortlund J, Mortz CG, Skov PS, Eller E, Poulsen JM, Borch JE, Bindslev-Jensen C. One-week oral challenge with penicillin in diagnosis of penicillin allergy. Acta Derm Venereol 2012; 92:307-12. [PMID: 22170236 DOI: 10.2340/00015555-1254] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Many patients experience reactions during penicillin treatment. The diagnosis may be difficult and is mainly based on short-term tests. The European Network for Drug Allergy (ENDA) guidelines proposed for diagnosing penicillin allergy do not include long-term challenge. In this study a total of 405 patients were evaluated. The ENDA guidelines were extended, to include a 7-day oral treatment (p.o.7) with penicillin for all patients who were negative in the ENDA programme. Among the 405 patients; 85 had an immediate reaction to penicillin, and a further 13 reacted during p.o.7. Among the 307 patients with a negative outcome, 88 had a case history of reaction to other β-lactam antibiotics and were subsequently tested with the culprit drug. Thirteen patients had a positive outcome: 3 on single-dose challenge and 10 during p.o.7. The extended penicillin diagnostic work-up was positive in 111 patients, 30.0% showed immediate reactions and 5.7% reacted during p.o.7. Approximately 20% of all patients with positive outcome during penicillin challenge are detected by adding p.o.7 with penicillin to the original ENDA guidelines.
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Affiliation(s)
- Janni Hjortlund
- Department of Dermatology and Allergy Centre, Odense University Hospital, DK-5000 Odense, Denmark.
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Moreno-Ancillo A, Gil-Adrados AC. Cefotaxim induced a near fatal anaphylactic shock in an infant. Allergol Immunopathol (Madr) 2012; 40:125-6. [PMID: 21621317 DOI: 10.1016/j.aller.2011.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 02/08/2011] [Accepted: 02/14/2011] [Indexed: 11/28/2022]
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Baeck M, Goossens A. New insights about delayed allergic hypersensitivity to corticosteroids. GIORN ITAL DERMAT V 2012; 147:65-69. [PMID: 22370569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Corticosteroids are among the most commonly used drugs, both topically and systemically. Although unexpected and paradoxical, allergic hypersensitivity to corticosteroids is a common finding, delayed-type reactions being much more frequently encountered than the immediate-type ones. With regard to cross-reactions between corticosteroids, based on patch-test results and molecular modelling, we were recently able to simplify the previous classification into 3 different groups, i.e., Group 1: the non-methylated, most often non-halogenated molecules (Group A, D2 and budesonide), which produce most of the allergic reactions; Group 2: the halogenated molecules with a C16/C17 cis ketal/diol structure (acetonide Group B); and Group 3: the halogenated and C16-methylated molecules (Group C and D1) that only rarely produce allergy.
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Affiliation(s)
- M Baeck
- Departement of Dermatology, Saint-Luc University Clinic, Louvain Catholic University, Bruxelles, Belgium
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