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Laguna JJ. Cefazolin dilemma in perioperative setting. Balancing surgical prophylaxis and allergic reactions. Anaesth Crit Care Pain Med 2024; 43:101375. [PMID: 38484932 DOI: 10.1016/j.accpm.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Affiliation(s)
- Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Universitario de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, REI, Madrid, Spain.
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Barbaud A, Garvey LH, Torres M, Laguna JJ, Arcolaci A, Bonadonna P, Scherer Hofmeier K, Chiriac AM, Cernadas J, Caubet JC, Brockow K. EAACI/ENDA position paper on drug provocation testing. Allergy 2024; 79:565-579. [PMID: 38155501 DOI: 10.1111/all.15996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 12/30/2023]
Abstract
In drug hypersensitivity, drug provocation testing (DPT), also called drug challenge, is the gold standard for investigation. In recent years, risk stratification has become an important tool for adjusting the diagnostic strategy to the perceived risk, whilst still maintaining a high level of safety for the patient. Skin tests are recommended before DPT but may be omitted in low-risk patients. The task force suggests a strict definition of such low-risk patients in children and adults. Based on experience and evidence from studies of allergy to beta-lactam antibiotics, an algorithm on how to adjust DPT to the risk, and when to omit skin tests before DPT, is presented. For other antibiotics, non-steroidal anti-inflammatory drugs and other drugs, skin tests are poorly validated and DPT is frequently necessary. We recommend performing DPT with chemotherapeutics and biologicals to avoid unnecessary desensitization procedures and DPT with skin tests negative contrast media. We suggest DPT with anesthetics only in highly specialized centers. Specifics of DPT to proton pump inhibitors, anticonvulsants and corticosteroids are discussed. This position paper provides general recommendations and guidance on optimizing use of DPT, whilst balancing benefits with patient safety and optimizing the use of the limited available resources.
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Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Service de dermatologie et allergologie, Paris, France
| | - Lene Heise Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Maria Torres
- Allergy Unit, Regional University Hospital of Malaga-IBIMA-UMA-ARADyAL, Malaga, Spain
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, ARADyAL, REI, Madrid, Spain
| | - Alessandra Arcolaci
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Patrizia Bonadonna
- Allergy Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Kathrin Scherer Hofmeier
- Allergy and Dermatology, Cantonal Hospital Aarau, Cantonal Hospital Aarau, Aarau, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Anca Mirela Chiriac
- Allergy Unit, University Hospital of Montpellier and IDESP, UMR UA11, Univ. Montpellier - INSERM, Montpellier, France
| | - Josefina Cernadas
- Hospital Lusíadas, Porto, Portugal
- Centro Hospitalar Universitário H. S. João, Porto, Portugal
| | - Jean Christoph Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University of Munich, Faculty of Medicine and Health, Munich, Germany
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3
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Barbaud A, Garvey LH, Arcolaci A, Brockow K, Mori F, Mayorga C, Bonadonna P, Atanaskovic-Markovic M, Moral L, Zanoni G, Pagani M, Soria A, Jošt M, Caubet JC, Carmo A, Mona AA, Alvarez-Perea A, Bavbek S, Benedetta B, Bilo MB, Blanca-López N, Bogas HG, Buonomo A, Calogiuri G, Carli G, Cernadas J, Cortellini G, Celik G, Demir S, Doña I, Dursun AB, Eberlein B, Faria E, Fernandes B, Garcez T, Garcia-Nunez I, Gawlik R, Gelincik A, Gomes E, Gooi JHC, Grosber M, Gülen T, Hacard F, Hoarau C, Janson C, Johnston SL, Joerg L, Kepil Özdemir S, Klimek L, Košnik M, Kowalski ML, Kuyucu S, Kvedariene V, Laguna JJ, Lombardo C, Marinho S, Merk H, Meucci E, Morisset M, Munoz-Cano R, Murzilli F, Nakonechna A, Popescu FD, Porebski G, Radice A, Regateiro FS, Röckmann H, Romano A, Sargur R, Sastre J, Scherer Hofmeier K, Sedláčková L, Sobotkova M, Terreehorst I, Treudler R, Walusiak-Skorupa J, Wedi B, Wöhrl S, Zidarn M, Zuberbier T, Agache I, Torres MJ. Allergies and COVID-19 vaccines: An ENDA/EAACI Position paper. Allergy 2022; 77:2292-2312. [PMID: 35112371 DOI: 10.1111/all.15241] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 09/13/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. METHOD Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. RESULTS No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. CONCLUSIONS These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.
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Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Lene Heise Garvey
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Alessandra Arcolaci
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital
| | - Cristobalina Mayorga
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga-Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | | | | | - Luis Moral
- Moral Luis. Pediatric Allergy and Respiratory Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Giovanna Zanoni
- Giovanna Zanoni, Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Mauro Pagani
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Italy
| | - Angèle Soria
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Departement de dermatologie et d'allergologie, Paris, France
| | - Maja Jošt
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Jean-Christoph Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Abreu Carmo
- Allergy and Clinical Immunology Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real and Allergy and Clinical Immunology Unit, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Al-Ahmad Mona
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Sevim Bavbek
- School of Medicine, Department of Pulmonary Diseases, Division of Allergy, FAAAI, Ankara University, Ankara, Turkey
| | - Biagioni Benedetta
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Disease, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - M Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit - Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Italy
| | | | - Herrera Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, and Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
| | - Alessandro Buonomo
- Allergy Unit - Fondazione Policlinico Gemelli IRCCS - Largo Gemelli, Rome, Italy
| | | | - Giulia Carli
- SOS Allergologia e Immunologia, Azienda USL Toscana Centro, Ospedale S. Stefano, Prato, Italy
| | - Josefina Cernadas
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, Porto and Allergy Unit, Hospital Lusíadas, Porto, Portugal
| | - Gabriele Cortellini
- Allergy Unit, Departments of Internal Medicine, Azienda Sanitaria della Romagna, Rimini, Hospital, Rimini, Italy
| | - Gülfem Celik
- Department of Chest Diseases, Division of Immunology and allergy, Ankara University School of Medicine cebeci Hospital, Ankara, Turkey
| | - Semra Demir
- Istanbul University, Istanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases, Istanbul, Turkey
| | - Inmaculada Doña
- Allergy Research Group, Allergy Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga-IBIMA, Plaza del Hospital Civil s/n, Málaga, Spain
| | | | - Bernadette Eberlein
- Faculty of Medicine, Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Emilia Faria
- Allergy and Clinical Immunology Unit, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Bryan Fernandes
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Tomaz Garcez
- Immunology Department, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Radoslaw Gawlik
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Asli Gelincik
- Istanbul University, Istanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases, Istanbul, Turkey
| | - Eva Gomes
- Allergy Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jimmy H C Gooi
- Department of Clinical Immunology, King's College Hospital, London, UK
| | - Martine Grosber
- Department of Dermatology, Universitair Ziekenhuis, Vrije Universiteit Brussel, Brussel, Belgium
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Florence Hacard
- Allergology and Clinical Immunology Department, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Cyrille Hoarau
- Service transversal d'allergologie et immunologie clinique, CHR de Tours, Tours, France
| | | | | | - Lukas Joerg
- Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seçil Kepil Özdemir
- Department of Chest Diseases, Division of Allergy and Immunology, Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Marek L Kowalski
- Department of Immunology and Allergy, Medical University of Lodz, Poland
| | - Semanur Kuyucu
- Faculty of Medicine, Dpt of Pediatric Allergy and Immunology, Mersin University, Mersin, Turkey
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and Allergology, Faculty of Medicine, Vilnius, Lithuania
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | | | - Susana Marinho
- Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK
| | | | - Elisa Meucci
- SOS Allergologia ed Immunologia clinica, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy
| | | | | | | | - Alla Nakonechna
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, UK
| | - Florin-Dan Popescu
- Department of Allergology, Carol Davila University of Medicine and Pharmacy, Nicolae Malaxa Clinical Hospital, Bucharest, Romania
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Radice
- SOS Allergologia ed Immunologia clinica, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Heike Röckmann
- Department of Dermatology, University Medical Centre Utrecht-Heidelberglaan 100, Utrecht, The Netherlands
| | | | - Ravishankar Sargur
- Clinical Immunology and Allergy Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joaquin Sastre
- Allergy Department, Fundación Jiménez Diaz, Universidad Autonoma de Madrid, CIBERES, Instituto de Salud Carlos III, Spain
| | | | | | - Marta Sobotkova
- Department of Immunology, Motol University Hospital and 2nd Faculty of Medicine Charles University, Prague, Czech Republic
| | | | - Regina Treudler
- Department of Dermatology, Venerology and Allergology, Universitätsmedizin Leipzig, Leipzig, Germany
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Walusiak-Skorupa Jolanta, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Bettina Wedi
- Department of Dermatology & Allergy, OE6600, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria
| | - Mihael Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, and Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Klinik für Dermatologie, Berlin, Germany
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain
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Nuñez-Borque E, Fernandez-Bravo S, Rodriguez Del Rio P, Alwashali EM, Lopez-Dominguez D, Gutierrez-Blazquez MD, Laguna JJ, Tome-Amat J, Gallego-Delgado J, Gomez-Lopez A, Betancor D, Cuesta-Herranz J, Ibañez-Sandin MD, Benito-Martin A, Esteban V. Increased miR-21-3p and miR-487b-3p serum levels during anaphylactic reaction in food allergic children. Pediatr Allergy Immunol 2021; 32:1296-1306. [PMID: 33876465 PMCID: PMC8453890 DOI: 10.1111/pai.13518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/03/2021] [Accepted: 04/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anaphylaxis is the most severe manifestation of allergic disorders. The poor knowledge of its molecular mechanisms often leads to under-diagnosis. MicroRNAs (miRNA) regulate physiologic and pathologic processes, and they have been postulated as promising diagnostic markers. The main objectives of this study were to characterize the human miRNA profile during anaphylaxis and to assess their capacity as diagnostic markers and determine their participation in the molecular mechanisms of this event. METHODS The miRNA serum profiles from the acute and baseline phase of 5 oral food-challenged anaphylactic children (<18 years old) were obtained by next-generation sequencing (NGS). From the panel of statistically significant miRNAs obtained, several candidates were selected and analyzed in 19 anaphylactic children by qPCR. We performed system biology analysis (SBA) on their target genes to identify main functions and canonical pathways. A functional in vitro assay was carried out incubating endothelial cells (ECs) in anaphylactic conditions. RESULTS The NGS identified 389 miRNAs among which 41 were significantly different between acute and baseline samples. The high levels of miR-21-3p (fold change = 2.28, P = .006) and miR-487b-3p (fold change = 1.04, P = .039) observed by NGS in acute serum samples were confirmed in a larger group of 19 patients. The SBA revealed molecular pathways related to the inflammation and immune system regulation. miR-21-3p increased intracellularly and in acute phase serum after EC stimulation. CONCLUSIONS These findings provide, for the first time, some insights into the anaphylactic miRNA serum profile in children and point to miR-21-3p and miR-487b-3p as candidate biomarkers. Furthermore, the SBA revealed a possible implication of these molecules in the underlying molecular mechanisms. Moreover, ECs increased miR-21-3p intracellularly and released it to the environment in response to anaphylaxis.
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Affiliation(s)
- Emilio Nuñez-Borque
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain
| | | | - Pablo Rodriguez Del Rio
- Allergy Department, Foundation for Biomedical Research, Niño Jesus University Children's Hospital, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain
| | - Ebrahim Mohammed Alwashali
- CAI Genomics and Proteomics, Proteomic Unit, Faculty of Pharmacy, Complutense University of Madrid, Madrid, Spain
| | - David Lopez-Dominguez
- Clinical Biostatistics Unit, Instituto de Investigación Puerta de Hierro (IDIPHIM), Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | | | - Jose Julio Laguna
- Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | - Jaime Tome-Amat
- Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Centro de Biotecnología y Genómica de Plantas (UPM-INIA), Universidad Politécnica de Madrid, Madrid, Spain
| | - Julio Gallego-Delgado
- Department of Biological Sciences, Lehman College, City University of New York, New York, NY, USA.,Program in Biology, The Graduate Center, The City University of New York, New York, NY, USA
| | | | | | - Javier Cuesta-Herranz
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Maria Dolores Ibañez-Sandin
- Allergy Department, Foundation for Biomedical Research, Niño Jesus University Children's Hospital, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain
| | | | - Vanesa Esteban
- Department of Allergy and Immunology, IIS-Fundación Jiménez Díaz, UAM, Madrid, Spain.,Instituto de Salud Carlos III, ARADyAL Network, Madrid, Spain.,Faculty of Biomedicine and Medicine, Alfonso X El Sabio University, Madrid, Spain
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5
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Nuñez‐Borque E, Fernandez‐Bravo S, Pastor‐Vargas C, Alvarez‐Llamas G, Gutierrez‐Blazquez MD, Alwashali E, Laguna JJ, Dionicio J, Betancor D, Villalobos V, Tome‐Amat J, Cuesta‐Herranz J, Benito‐Martin A, Esteban V. Proteomic profile of extracellular vesicles in anaphylaxis and their role in vascular permeability. Allergy 2021; 76:2276-2279. [PMID: 33629411 PMCID: PMC8360103 DOI: 10.1111/all.14792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/02/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Emilio Nuñez‐Borque
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
| | | | - Carlos Pastor‐Vargas
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
- Department of Biochemistry and Molecular Biology Universidad Complutense de Madrid Madrid Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
| | - Gloria Alvarez‐Llamas
- Immunoallergy and Proteomics Laboratory IIS‐Fundación Jiménez DíazUAM Madrid Spain
- Red de Investigación Renal (REDINREN) Instituto de Salud Carlos III Madrid Spain
| | | | - Ebrahim Alwashali
- CAI Genomics and Proteomics Proteomic Unit Faculty of Pharmacy Complutense University of Madrid Madrid Spain
| | - Jose Julio Laguna
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
- Allergy Unit, Allergo‐Anaesthesia Unit Hospital Central de la Cruz Roja Madrid Spain
- Faculty of Medicine and Biomedicine Alfonso X El Sabio University Madrid Spain
| | - Javier Dionicio
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
- Allergy Unit, Allergo‐Anaesthesia Unit Hospital Central de la Cruz Roja Madrid Spain
| | - Diana Betancor
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
| | - Victoria Villalobos
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
| | - Jaime Tome‐Amat
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
- Centro de Biotecnología y Genómica de Plantas (UPM‐INIA) Universidad Politécnica de Madrid Madrid Spain
| | - Javier Cuesta‐Herranz
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
| | - Alberto Benito‐Martin
- Department of Medicine Weill Cornell Medicine New York New York USA
- Instituto Biomedico de Nutrición y Salud IBIONS Spain
| | - Vanesa Esteban
- Department of Allergy and Immunology IIS‐Fundación Jiménez DíazUAM Madrid Spain
- Red de asma, reacciones adversas y alérgicas (ARADyAL)Instituto de Salud Carlos III Madrid Spain
- Faculty of Medicine and Biomedicine Alfonso X El Sabio University Madrid Spain
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6
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Jurado-Escobar R, Doña I, Perkins JR, Laguna JJ, Muñoz-Cano R, García-Sánchez A, Ayuso P, Torres MJ, Mayorga C, Cornejo-García JA. Polymorphisms in eicosanoid-related biosynthesis enzymes associated with acute urticaria/angioedema induced by nonsteroidal anti-inflammatory drug hypersensitivity. Br J Dermatol 2021; 185:815-824. [PMID: 33955560 DOI: 10.1111/bjd.20440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Nonsteroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity, with NSAID-induced acute urticaria/angioedema (NIUA) the most frequent phenotype. NSAID hypersensitivity is caused by cyclooxygenase 1 inhibition, which leads to an imbalance in prostaglandin (PG) and cysteinyl leukotriene (CysLT) synthesis. As only susceptible individuals develop NSAID hypersensitivity, genetic factors are believed to be involved; however, no study has assessed the overall genetic variability of key enzymes in PG and CysLT synthesis in NSAID hypersensitivity. OBJECTIVES To evaluate simultaneously variants in the main genes involved in PG and CysLT biosynthesis in NIUA. METHODS Two independent cohorts of patients were recruited in Spain, alongside NSAID-tolerant controls. The discovery cohort included only patients with NIUA; the replication cohort included patients with NSAID-exacerbated respiratory disease (NERD). A set of tagging single-nucleotide polymorphisms (tagSNPs) in PTGS1, PTGS2, ALOX5 and LTC4S was genotyped using mass spectrometry coupled with endpoint polymerase chain reaction. RESULTS The study included 1272 individuals. Thirty-five tagSNPs were successfully genotyped in the discovery cohort, with three being significantly associated after Bonferroni correction (rs10306194 and rs1330344 in PTGS1; rs28395868 in ALOX5). These polymorphisms were genotyped in the replication cohort: rs10306194 and rs28395868 remained associated with NIUA, and rs28395868 was marginally associated with NERD. Odds ratios (ORs) in the combined analysis (discovery and replication NIUA populations) were 1·7 for rs10306194 [95% confidence interval (CI) 1·34-2·14; Pcorrected = 2·83 × 10-4 ) and 2·19 for rs28395868 (95% CI 1·43-3·36; Pcorrected = 0·002). CONCLUSIONS Variants of PTGS1 and ALOX5 may play a role in NIUA and NERD, supporting the proposed mechanisms of NSAID-hypersensitivity and shedding light on their genetic basis.
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Affiliation(s)
- R Jurado-Escobar
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Departments of, Department of, Medicine, University of Malaga, Malaga, Spain
| | - I Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain
| | - J R Perkins
- Department of, Molecular Biology and Biochemistry, University of Malaga, Malaga, Spain.,CIBER de Enfermedades Raras (CIBERER), ISCIII, Madrid, Spain.,The Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - J J Laguna
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Unidad de Alergia, Hospital Central de la Cruz Roja, Madrid, Spain
| | - R Muñoz-Cano
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Allergy Section, Pneumology Department, Hospital Clinic, Universitat de Barcelona, ARADyAL, Barcelona, Spain
| | - A García-Sánchez
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Department of Clinical Biochemistry, Pharmacogenetics Unit, University Hospital of Salamanca, Salamanca, Spain
| | - P Ayuso
- ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Department of Pharmacology, University of Extremadura, Caceres, Spain
| | - M J Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Departments of, Department of, Medicine, University of Malaga, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| | - C Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| | - J A Cornejo-García
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Malaga, Spain.,ARADyAL Network, Instituto de Salud Carlos III, Madrid, Spain
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7
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Audicana A, Ortega N, Lobera T, Blanca N, De la Parte B, García I, Gelis S, Martín J, Barranco R, Vila C, Laguna JJ. Spanish Society vision of Drug challenge tests. J Investig Allergol Clin Immunol 2021; 31:385-403. [PMID: 33653682 DOI: 10.18176/jiaci.0681] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The controlled drug exposure test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Drug-induced adverse reactions (ADRs) are a growing reason for consultation in both primary and specialized care. Allergology consultations in Spain are the ones that usually study these ADRs and rule out immunological mechanisms involved in up to 90% of the cases consulted. An adequate approach to these cases has an obvious impact on the costs and efficacy of the treatments required by other specialists, so that if we did not use DPTs, patients would require more expensive, more toxic and less effective treatments in most of the cases. In recent years, a large number of new drugs have been developed and this document is intended to be a practical guide in the management of PDT with the vision of the Spanish Allergology Society. Diagnostic work begins with a detailed history of the patient. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although there is usually cross-reactivity, DPTs can confirm the diagnosis and also help to find a tolerable alternative drug. The individual management of patients in a programmed way, taking into account both the type of drug to be studied and the patient´s comorbidities, usually allows a solution to be found for the majority of patients.
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Affiliation(s)
- A Audicana
- Servicio de Alergología e Inmunología Clínica, Hospital Universitario Araba, OSI Araba, Vitoria, Spain
| | - N Ortega
- Servicio de Alergología, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - T Lobera
- Sección de Alergología, Hospital Universitario de San Pedro, Logroño, La Rioja, Spain
| | - N Blanca
- Servicio de Alergología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - B De la Parte
- Servicio de Alergología, Hospital del Tajo, Aranjuez, Spain
| | - I García
- Servicio de Alergología, Hospital Quirón Salud Campo de Gibraltar y Hospital Quiron Salud Córdoba, Spain
| | - S Gelis
- Unidad de Alergia, Servicio de Neumología, Hospital Clinic, Institut d'investigacions Biomediques August Pi i Sunyer (IDIPAPS), Barcelona, Spain
| | - J Martín
- Servicio de Alergología, Hospital San Rafael, La Coruña, Spain
| | - R Barranco
- Servicio de Alergología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C Vila
- Unidad de Alergia, Hospital Universitario Severo Ochoa, Leganés. Madrid, Spain
| | - J J Laguna
- Unidad de Alergia, Unidad de Alergoanestesia, Hospital Central de la Cruz Roja. Madrid, Spain
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8
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Doña I, Bogas G, Salas M, Testera A, Moreno E, Laguna JJ, Torres MJ. Hypersensitivity Reactions to Multiple Iodinated Contrast Media. Front Pharmacol 2020; 11:575437. [PMID: 33071787 PMCID: PMC7538657 DOI: 10.3389/fphar.2020.575437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/04/2020] [Indexed: 01/07/2023] Open
Abstract
The incidence of hypersensitivity reactions (HSRs) to iodinated contrast media (ICM) has risen over last years, representing an important health problem. HSRs to ICMs are classified into immediate reactions (IRs) and non-immediate reactions (NIRs) according to if they occur within 1 h or longer after ICM administration. The diagnosis of HSRs to ICM is complex as skin test (ST) sensitivity ranges widely, and drug provocation test (DPT) protocols are heterogeneous. In this manuscript, we describe the clinical characteristics of a series of patients confirmed as HSR to ICM and the diagnosis procedure carried out, looking into those cases confirmed as HSRs to multiple ICMs. For this purpose, we prospectively evaluated patients suggestive of HSRs to ICMs and classified them as IRs or NIRs. STs were carried out using a wide panel of ICMs, and in those with a negative ST, a single-blind placebo controlled DPT was performed with the culprit. If ST or DPT were positive, then tolerance was assessed with an alternative negative ST ICM. We included 101 cases (12 IRs and 89 NIRs) confirmed as allergic. Among them, 36 (35.64%) cases were allergic to more than one ICM (8 IRs and 28 NIRs). The most common ICM involved were iomeprol and iodixanol. Although not statistically significant, the percentage of patients reporting anaphylaxis was higher in patients allergic to multiple ICMs compared with patients allergic to a single ICM (50 vs. 25%). Likewise, the percentage of positive results in STs was higher in patients allergic to multiple ICMs compared with those allergic to a single ICM (for IR 62.5 vs. 25%, p > 0.05; and for NIR, 85.71 vs. 24.59%, p < 0.000). In cases allergic to more than one ICM, DPT with negative-ST ICM was positive in more than 60% (24/36) of cases. Therefore, allergy to multiple ICMs is common, associated to severe reactions in IRs, and confirmed frequently by positive STs. The allergological work-up should include DPT not only to establish the diagnosis but also to identify safe alternative ICM, even if ICM is structurally unrelated and ST is negative. More studies are needed to clarify mechanisms underlying cross-reactivity among ICMs.
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Affiliation(s)
- Inmaculada Doña
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Gádor Bogas
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - María Salas
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Almudena Testera
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | - Esther Moreno
- Allergy Unit, University Hospital of Salamanca, Instituto de Investigación Biomédica de Salamanca-IBSAL, ARADyAL, Salamanca, Spain
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University. ARADyAL, Madrid, Spain
| | - María José Torres
- Allergy Unit, Hospital Regional Universitario de Málaga, Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain.,Nanostructures for Diagnosing and Treatment of Allergic Diseases Laboratory, Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain
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9
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Mendez-Barbero N, Yuste-Montalvo A, Nuñez-Borque E, Jensen BM, Gutiérrez-Muñoz C, Tome-Amat J, Garrido-Arandia M, Díaz-Perales A, Ballesteros-Martinez C, Laguna JJ, Beitia J, Poulsen LK, Cuesta-Herranz J, Blanco-Colio LM, Esteban V. The TNF-like weak inducer of the apoptosis/fibroblast growth factor–inducible molecule 14 axis mediates histamine and platelet-activating factor–induced subcutaneous vascular leakage and anaphylactic shock. J Allergy Clin Immunol 2020; 145:583-596.e6. [DOI: 10.1016/j.jaci.2019.09.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 08/11/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023]
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10
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Cuesta-Herranz J, Laguna JJ, Mielgo R, Pérez-Camo I, Callejo AM, Begoña L, Gomez MC, Madariaga B, Martinez A. Quality of life improvement with allergen immunotherapy treatment in patients with rhinoconjunctivitis in real life conditions. Results of an observational prospective study (ÍCARA). Eur Ann Allergy Clin Immunol 2019; 51. [PMID: 31287263 DOI: 10.23822/eurannaci.1764-1489.104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Summary Objectives. Evaluate the changes in quality of life of patients with allergic rhinoconjunctivitis (AR), with or without asthma, after one-year treatment with allergen immunotherapy. Methods. This was an observational prospective multicenter study. RQLQ questionnaire and VAS scale to assess treatment satisfaction were used. Impact on AR and asthma was also analyzed. Any adverse reaction was recorded. Results. 127 patients were recruited. Mean values in RQLQ decreased from 2.61 to 1.34 points, reflecting a statistically and clinically significant improvement (p minor 0.01). The percentage of asthmatic patients decreased significantly (p minor 0.01). Mean value of patients' satisfaction was 7.24 (SD = 1.90). Only 11 patients presented systemic reactions (9.17%), none of them serious. Conclusions. One-year AIT treatment significantly increases QoL in patients with AR. Moreover, high patients' satisfaction values were reported, together with an adequate safety profile.
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Affiliation(s)
| | - J J Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
| | - R Mielgo
- Hospital 12 de Octubre, Allergy Department, Madrid, Spain
| | - I Pérez-Camo
- Hospital Royo Villanova, Allergy Department, Zaragoza, Spain
| | - A M Callejo
- Hospital Virgen de la Concha, Allergy Department, Zamora, Spain
| | - L Begoña
- ROXALL Medicina España S.A., R and D Department, Zamudio, Bizkaia, Spain
| | - M C Gomez
- ROXALL Medicina España S.A., R and D Department, Zamudio, Bizkaia, Spain
| | - B Madariaga
- ROXALL Medicina España S.A., R and D Department, Zamudio, Bizkaia, Spain
| | - A Martinez
- ROXALL Medicina España S.A., R and D Department, Zamudio, Bizkaia, Spain
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11
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Garvey LH, Dewachter P, Hepner DL, Mertes PM, Voltolini S, Clarke R, Cooke P, Garcez T, Guttormsen AB, Ebo DG, Hopkins PM, Khan DA, Kopac P, Krøigaard M, Laguna JJ, Marshall S, Platt P, Rose M, Sabato V, Sadleir P, Savic L, Savic S, Scherer K, Takazawa T, Volcheck GW, Kolawole H. Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations. Br J Anaesth 2019; 123:e50-e64. [DOI: 10.1016/j.bja.2019.04.044] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/04/2019] [Accepted: 04/14/2019] [Indexed: 12/11/2022] Open
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12
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Savic LC, Khan DA, Kopac P, Clarke RC, Cooke PJ, Dewachter P, Ebo DG, Garcez T, Garvey LH, Guttormsen AB, Hopkins PM, Hepner DL, Kolawole H, Krøigaard M, Laguna JJ, Marshall SD, Mertes PM, Platt PR, Rose MA, Sabato V, Sadleir PHM, Savic S, Takazawa T, Voltolini S, Volcheck GW. Management of a surgical patient with a label of penicillin allergy: narrative review and consensus recommendations. Br J Anaesth 2019; 123:e82-e94. [PMID: 30916014 DOI: 10.1016/j.bja.2019.01.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022] Open
Abstract
Unsubstantiated penicillin-allergy labels are common in surgical patients, and can lead to significant harm through avoidance of best first-line prophylaxis of surgical site infections and increased infection with resistant bacterial strains. Up to 98% of penicillin-allergy labels are incorrect when tested. Because of the scarcity of trained allergists in all healthcare systems, only a minority of surgical patients have the opportunity to undergo testing and de-labelling before surgery. Testing pathways can be modified and shortened in selected patients. A variety of healthcare professionals can, with appropriate training and in collaboration with allergists, provide testing for selected patients. We review how patients might be assessed, the appropriate testing strategies that can be used, and the minimum standards of safe testing.
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Affiliation(s)
- L C Savic
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - D A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - P Kopac
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - R C Clarke
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia
| | - P J Cooke
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - P Dewachter
- Service d'Anesthésie-Réanimation, Groupe Hospitalier de Paris-Seine-Saint-Denis, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris 13, Sorbonne-Paris-Cité, Paris, France
| | - D G Ebo
- Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium
| | - T Garcez
- Department of Immunology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - L H Garvey
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - A B Guttormsen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - P M Hopkins
- Anaesthetic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - D L Hepner
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, USA
| | - H Kolawole
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia
| | - M Krøigaard
- Danish Anaesthesia Allergy Centre, Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital, Gentofte, Denmark
| | - J J Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Hospital Central de la Cruz Roja, Faculty of Medicine, Alfonso X El Sabio University, ARADyAL, Madrid, Spain
| | - S D Marshall
- Department of Anaesthesia and Perioperative Medicine, Monash University, Melbourne, Australia; Department of Anaesthesia, Peninsula Health, Melbourne, Australia
| | - P M Mertes
- Department of Anesthesia and Intensive Care, Hôpitaux Universitaires de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - P R Platt
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia
| | - M A Rose
- Department of Anaesthesia, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia
| | - V Sabato
- Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerp University Hospital, Belgium
| | - P H M Sadleir
- Department of Anaesthesia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia; Anaesthetic Allergy Referral Centre of Western Australia, Nedlands, Western Australia, Australia; Department of Pharmacology, University of Western Australia, Crawley, Western Australia, Australia
| | - S Savic
- Department of Clinical Immunology and Allergy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Takazawa
- Intensive Care Unit, Gunma University Hospital, Maebashi, Gunma, Japan
| | - S Voltolini
- Allergy Unit, Policlinic Hospital San Martino, Genoa, Italy
| | - G W Volcheck
- Division of Allergic Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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13
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Laguna JJ, Archilla J, Doña I, Corominas M, Gastaminza G, Mayorga C, Berjes-Gimeno P, Tornero P, Martin S, Planas A, Moreno E, Torres MJ. Practical Guidelines for Perioperative Hypersensitivity Reactions. J Investig Allergol Clin Immunol 2018; 28:216-232. [DOI: 10.18176/jiaci.0236] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Salas M, Fernández-Santamaría R, Mayorga C, Barrionuevo E, Ariza A, Posadas T, Laguna JJ, Montañez MI, Molina N, Fernández TD, Torres MJ. Use of the Basophil Activation Test May Reduce the Need for Drug Provocation in Amoxicillin-Clavulanic Allergy. The Journal of Allergy and Clinical Immunology: In Practice 2018; 6:1010-1018.e2. [DOI: 10.1016/j.jaip.2017.08.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/26/2017] [Accepted: 08/16/2017] [Indexed: 11/30/2022]
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15
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Arribas F, Falkencrone S, Sola J, Gomez-Serranillos MP, Laguna JJ, Montañez MI, Fernandez TD, Rodríguez D, Pineda F, Skov PS, Mayorga C, Torres MJ. Basophil Histamine Release Induced by Amoxicilloyl-poly-L-lysine Compared With Amoxicillin in Patients With IgE-Mediated Allergic Reactions to Amoxicillin. J Investig Allergol Clin Immunol 2017. [PMID: 28628008 DOI: 10.18176/jiaci.0180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Amoxicillin (AX) is the ß-lactam most often involved in IgE-mediated reactions. Diagnosis is based mainly on skin testing, although sensitivity is not optimal. We produced a new AX derivative, amoxicilloyl-poly-L-lysine (APL), and analyzed its recognition of IgE using the passive histamine release test (pHRT). METHODS The study population comprised patients (n=19) with confirmed AX allergy and specific IgE to AX and controls (n=10) with good tolerance to AX. pHRT was performed using "IgE-stripped" blood from a single donor that was sensitized in vitro by patient sera and incubated with AX or APL. Histamine release was determined and expressed as nanograms of histamine released per milliliter of blood. RESULTS The clinical symptoms were anaphylaxis (n=9), urticaria (n=7), erythema (n=2), and nondefined immediate reactions (n=1). The median (IQR) time interval between reaction and study was 90 (60-240) days and between drug intake and development of symptoms 24 (10-60) minutes. The median sIgE level was 3.37 (0.95-5.89) kUA/L. The sensitivity of pHRT to APL was 79% and the specificity 100%, which were higher than data obtained with pHRT to AX (63% sensitivity and 90% specificity). There was a positive correlation between maximal histamine release levels obtained with AX and APL (r=0.63). CONCLUSIONS In patients with immediate hypersensitivity reactions to AX, APL showed higher sensitivity and specificity than the culprit drug, AX, when tested in vitro by pHRT. This indicates that APL can improve the in vitro diagnostic accuracy of allergic reactions to AX. Further assessment of skin testing is necessary.
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Affiliation(s)
| | - S Falkencrone
- Department of Dermatology, University Hospital of Odense, Denmark and Charité, Berlin, Germany
| | - J Sola
- Allergy Service, Ramon y Cajal Hospital, Madrid, Spain
| | | | - J J Laguna
- Allergy Unit, Cruz Roja Hospital, Madrid, Spain
| | - M I Montañez
- Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - T D Fernandez
- Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | | | - F Pineda
- Diater Laboratorios, Madrid, Spain
| | - P S Skov
- Department of Dermatology, University Hospital of Odense, Denmark and Charité, Berlin, Germany
| | - C Mayorga
- Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
| | - M J Torres
- Allergy Unit, IBIMA-Regional University Hospital of Malaga UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology - BIONAND, Málaga, Spain
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16
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Montañez MI, Mayorga C, Bogas G, Barrionuevo E, Fernandez-Santamaria R, Martin-Serrano A, Laguna JJ, Torres MJ, Fernandez TD, Doña I. Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis. Front Immunol 2017; 8:614. [PMID: 28611774 PMCID: PMC5446992 DOI: 10.3389/fimmu.2017.00614] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/09/2017] [Indexed: 12/14/2022] Open
Abstract
Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE) antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.
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Affiliation(s)
- Maria Isabel Montañez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | - Cristobalina Mayorga
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Gador Bogas
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Esther Barrionuevo
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | | | - Angela Martin-Serrano
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain.,Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain
| | | | - Maria José Torres
- Andalusian Center for Nanomedicine and Biotechnology-BIONAND, Málaga, Spain.,Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Tahia Diana Fernandez
- Research Laboratory, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Unit, IBIMA-Regional University Hospital of Malaga-UMA, Málaga, Spain
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Elera JD, Boteanu C, Blanco MAJ, Gonzalez-Mendiola R, García IC, Alvarez A, Martinez JJL, Garrido JM, Barona CT, Chorda CP, Salgueiro RL, Palacios MD, De Rojas DHF, Acar EA, Aktas A, Ermertcan AT, Temiz P, Lin CY, Hui CYR, Chang YC, Yang CH, Chung WH, Carolino F, Silva D, De Castro ED, Cernadas JR, Ensina LF, Aranda C, Nunes IC, Lacerda A, Martins AM, Goudouris E, Ribeiro M, Da Silva Franco JF, Queiroz L, Solé D, Dalgiç CT, Sin AZ, Günsen FD, Bulut G, Ardeniz FÖ, Gülbahar O, Gökmen ENM, Kokuludag A, De Francisco AMM, De Vicente Jiménez TM, Mendoza Parra AM, Burgos Pimentel AM, Luque AG, Amaral L, Leão LC, Pinto N, Belo J, Marques J, Carreiro-Martins P, Leiria-Pinto P, Chaabane A, Romdhane HB, Fredj NB, Chadly Z, Boughattas NA, Aouam K, Uyttebroek AP, Bridts CH, Romano A, Ebo DG, Sabato V, Lopes A, Cosme J, Aguiar R, Lourenço T, Paes MJ, Spínola-Santos A, Pereira-Barbosa M, Cruz CR, Dos Reis RP, Tomaz E, Pires AP, Inácio F, Benito-Garcia F, Mota I, Correia M, Gaspar Â, Chambel M, Piedade S, Morais-Almeida M, Nakonechna A, Antipkin Y, Umanets T, Pineda F, Arribas F, Lapshyn V, Miranda PA, De La Cruz Hoyos B, Blanco AJ, Del Pozo M, Vultaggio A, Nencini F, Pratesi S, Matucci A, Maggi E, Cegec I, Nahal DJ, Turk VE, Aumiler MR, Ausperger KM, Kraljickovic I, Simic I, Yamaguchi Y, Watanabe T, Satoh M, Tanegashima T, Oda K, Wada H, Aihara M, Lee JJ, Choi JC, Lee HY, Fernandes RAR, Faria E, Pita J, Sousa N, Ribeiro C, Carrapatoso I, Bom AT, Rodolfo A, Dias-Castro E, Voronova M, Valle DK, Coronel VP, Chordá CP, Madamba RCY, Ferrer M, Goikoetxea MJ, D’Amelio C, Bernad A, Vega O, Gastaminza G, Bibián BP, Salazar ML, Vilà-Nadal G, Roman AMF, Ortega JD, Muñoz MG, Gancedo SQ, Moreno MRC, Hofmeier KS, Barzylovych V, Pola B, Lluncor M, Fiandor A, Bellón T, Domínguez J, Quirce S, Yang MS, Kim SS, Kim SH, Kang HR, Park HW, Cho SH, Min KU, Chang YS, Delahaye C, Flabbee J, Waton J, Bauvin O, Barbaud A, Fadhel NB, Gulin SJ, Chiriac A, Cardoso BK, Viseu R, Moreira A, Cadinha S, Neves AC, Barreira P, Malheiro D, Da Silva JPM, Jurakic-Toncic R, Ljubojevic S, Turcic P, Gilissen L, Huygens S, Goossens A, Andreu I, Romero AM, Cabezas PG, Parejo PA, Del Carmen Plaza-Serón M, Doña I, Blanca-López N, Flores C, Galindo ML, Molina A, Perkins JR, Cornejo-García JA, García-Agúndez JA, García-Martín E, Campo P, Canto MG, Blanca M, Guéant-Rodríguez RM, Jurado-Escobar R, Barrionuevo E, Salas M, Canto G, Guéant JL, Usui T, Tailor A, Faulkner L, Farrell J, Alfirevic A, Kevin Park B, Naisbitt DJ, Trelles O, Guerrero MA, Upton A, Ueta M, Sawai H, Sotozono C, Tokunaga K, Kinoshita S, Sukasem C, Satapornpong P, Tempark T, Rerknimitr P, Pairayayutakul K, Klaewsongkram J, Koomdee N, Jantararoungtong T, Santon S, Puangpetch A, Intusoma U, Tassaneeyakul W, Theeramoke V, Ramirez E, Borobia AM, Tong H, Castañer JL, De Abajo FJ, Galvao VR, Pavlos R, Mckinnon E, Williams K, Beeghly-Fadiel A, Redwood A, Phillips E, Castells M, Boni E, Russello M, Mauro M, Ue KL, Rutkowski K, Gomis VS, Ferre JF, Rodriguez AE, Reig VC, Sanchez JF, Breynaert C, Van Hoeyveld E, Schrijvers R, Blanco AJ, Irigoyen RF, Collado D, Vida Y, Najera F, Perez-Inestrosa E, Mesa-Antunez P, Mayorga C, Torres MJ, Tannert LK, Mortz CG, Skov PS, Bindslev-Jensen C, Pfützner W, Dörnbach H, Visse J, Rauber M, Möbs C, Elzagallaai AA, Chow L, Abuzgaia AM, Rieder MJ, Trubiano J, Woolnough E, Stautins K, Cheng C, Kato K, Azukizawa H, Hanafusa T, Katayama I, Fujiyama T, Hashizume H, Umayahara T, Ito T, Tokura Y, Silar M, Zidarn M, Rupnik H, Korosec P, Redwood AJ, Strautins K, White K, Chopra A, Konvinse K, Leary S, Mallal S, Cabañas R, Fiandor AM, Sullivan A, Whitaker P, Peckham D, Haw WY, Polak ME, Mcguire C, Ardern-Jones MR, Aoyama Y, Shiohara T, Correia S, Gelincik A, Demir S, Sen F, Bozbey HU, Olgac M, Unal D, Coskun R, Colakoglu B, Buyuozturk S, Çatin-Aktas E, Deniz G, Laguna JJ, Dionicio J, Fernandez T, Olazabal I, Ruiz MD, Torres MJ, Lafuente A, Núñez J, Fernández TD, Palomares F, Fernández R, Sanchez MI, Fernandez T, Ruiz A, Ariza A, Alonso AB, Garófalo CD, Matute OV, Puga MF, Lapresa MJG, Lasarte GG, Thinnes A, Merk HF, Baron JM, Leverkus M, Balakirski G, Gibson A, Ogese M, Al-Attar Z, Yaseen F, Meng X, Jenkins R, Farrel J, Alhilali K, Xue Y, Illing P, Mifsud N, Fettke H, Lai J, Ho R, Kwan P, Purcell A, Ogese MO, Betts C, Thomson P, Alhaidari M, Berry N, O’Neill PM, Alzahrani A, Azoury ME, Fili L, Bechara R, Scornet N, Nhim C, Weaver R, Claude N, Joseph D, Maillere B, Parronchi P, Pallardy M, Villani AP, Rozières A, Bensaïd B, Tardieu M, Albert F, Mutez V, Baysal T, Maryanski J, Nicolas JF, Kanagawa O, Vocanson M, Hung SI, Harrison CJ, Jenkins RE, French NS, Montañez MI, Fernandez TD, Martin-Serrano A, Torres MJ, Molina N, Wood S, Pirmohamed M, Montañez MI, Martín-Serrano Á, Pérez-Inestrosa E, Pérez-Sala D, Guzmán AE, Ko TM, Chen YT, Wu JY, Sánchez-Gómez FJ, González-Morena JM, Torres MJ, Arreola AM, Corona JAB, Flores SM, Cherit JD, Figueroa NVD, Flores JLC, Perkins J, Pérez-Alzate D, Bogas G, Torres MJ, Marti LMT, De La Losa FP, Poves FA, Lopez JT, Santiago TL. 7th Drug hypersensitivity meeting: part two. Clin Transl Allergy 2016. [PMCID: PMC5009521 DOI: 10.1186/s13601-016-0122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ayuso P, Carmen Plaza-Serón MD, Blanca-López N, Doña I, Campo P, Laguna JJ, Bartra J, Soriano-Gomis V, Torres MJ, Blanca M, Cornejo-Garcia JA, Perkins JR. Genetic Variants in Arachidonic Acid Pathway Genes Associated with Nsaids-Exacerbated Respiratory Disease. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pineda F, Ariza A, Mayorga C, Perez I, Gonzalez‐Mendiola R, Blanca N, Davila G, Cabañes N, Canto G, Laguna JJ, Senent C, Skov PS, Palacios R, Blanca M. Diagnostic usefulness of histamine release test (HRT) and skin tests in IgE‐mediated allergy to clavulanic acid. Clin Transl Allergy 2014. [PMCID: PMC4128304 DOI: 10.1186/2045-7022-4-s3-o7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Adriana Ariza
- IBIMARegional University Hospital of Malaga, UMAAllergy UnitSpain
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Parejo PA, Plaza-Serón MDC, Doña I, Blanca-López N, Cornejo-Garcia JA, Torres MJ, Fernández J, Laguna JJ, Osorio M, Godineau V, Galindo L, Mayorga C, Canto G, Blanca M. Association Study Of Genes Involved In Mast Cell Activation and Mnsaid-UA. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cornejo-Garcia JA, Lee M, Blanca-López N, Liou LB, Chen CH, Doña I, Godineau V, Laguna JJ, Javier Fernandez F, Parejo PA, Plaza-Serón MDC, Canto G, Blanca M. Non-Steroidal Antiinflammatory Drugs (NSAIDs)-Induced Acute Urticaria: A Genome-Wide Association Study In The Spanish Population. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cornejo-García JA, Jagemann LR, Blanca-López N, Doña I, Flores C, Guéant-Rodríguez RM, Torres MJ, Fernández J, Laguna JJ, Rosado A, Agúndez JAG, García-Martín E, Canto G, Guéant JL, Blanca M. Genetic variants of the arachidonic acid pathway in non-steroidal anti-inflammatory drug-induced acute urticaria. Clin Exp Allergy 2013. [PMID: 23181793 DOI: 10.1111/j.1365-2222.2012.04078.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND To date, genetic studies of hypersensitivity reactions to non-steroidal anti-inflammatory drugs (NSAIDs) have been carried out mainly in aspirin-induced asthma and to a lesser extent in chronic urticaria, with no studies in patients with acute urticaria (AU), the most common entity induced by these drugs. OBJECTIVE In this work, we analysed the association of common variants of 15 relevant genes encoding both enzymes and receptors from the arachidonic acid (AA) pathway with NSAID-induced AU. METHODS Patients were recruited in several Allergy Services that are integrated into the Spanish network RIRAAF, and diagnosed of AU induced by cross-intolerance (CRI) to NSAIDs. Genotyping was carried out by TaqMan allelic discrimination assays. RESULTS A total of 486 patients with AU induced by CRI to NSAIDs and 536 unrelated controls were included in this large Spanish case-control study. Seven variants from 31 tested in six genes were associated in a discovery study population from Malaga (0.0003 ≤ p-value ≤ 0.041). A follow-up analysis in an independent sample from Madrid replicated three of the SNPs from the ALOX15 (rs7220870), PTGDR (rs8004654) and CYSLTR1 (rs320095) genes (1.055x10(-6) ≤meta-analysis p-value ≤ 0.003). CONCLUSIONS AND CLINICAL RELEVANCE Genetic variants of the AA pathway may play an important role in NSAID-induced AU. These data may help understand the mechanism underlying this disease.
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Affiliation(s)
- J A Cornejo-García
- INSERM U-954, Nutrition-Génétique et exposition aux risques environmentaux, Faculty of Medicine, University of Nancy, Vandoeuvre-les-Nancy, France.
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Lee MT, Cornejo-Garcia JA, Chen YT, Chen CH, Blanca-López N, Doña I, Torres MJ, Rondon C, Campo P, Laguna JJ, Fernandez FJ, Parejo PA, Plaza-Serón MDC, Gandolfo Cano MDM, Ingelmo AR, Canto G, Blanca M. A Genome-Wide Association Study of Non-Steroidal Antiinflammatory Drugs (NSAIDs)-Induced Acute Urticaria in the Spanish Population. J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Parejo PA, García-Agúndez JA, Cornejo-Garcia JA, Blanca M, Torres MJ, Doña I, Salas M, Blanca-López N, Canto G, Rondon C, Campo P, Laguna JJ, Fernandez FJ, Martínez C, García-Martín E. Association Study of Functional Polymorphisms in Genes Involved in Histamine Homeostasis and Multiple NSAID–Triggered Urticaria and/or Angioedema and Anaphylaxis in Patients without Pre-Existing Chronic Urticaria (MNSAID-UA). J Allergy Clin Immunol 2013. [DOI: 10.1016/j.jaci.2012.12.1266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Davila-Fernández G, Sánchez-Morillas L, Rojas P, Laguna JJ. Urticaria due to an intradermal test with articaine hydrochloride. J Investig Allergol Clin Immunol 2012; 22:373-374. [PMID: 23101314] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
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Doña I, Blanca-López N, Jagemann LR, Torres MJ, Rondón C, Campo P, Gómez AI, Fernández J, Laguna JJ, Rosado A, Blanca M, Canto G. Response to a selective COX-2 inhibitor in patients with urticaria/angioedema induced by nonsteroidal anti-inflammatory drugs. Allergy 2011; 66:1428-33. [PMID: 21834936 DOI: 10.1111/j.1398-9995.2011.02684.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [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: 11/27/2022]
Abstract
BACKGROUND In subjects with hypersensitivity reactions with cross-intolerance to nonsteroidal anti-inflammatory drugs (NSAIDs), tolerance to selective COX-2 inhibitors has not been evaluated in large series of well-phenotyped cases. METHODS We evaluated 252 patients with urticaria and/or angioedema caused by hypersensitivity owing to cross-intolerance to NSAIDs. In addition to the clinical history, diagnosis was confirmed by provocation to an alternative NSAID. Two groups were considered: (A) patients with cross-intolerance to NSAIDs and intolerance to paracetamol and (B) patients with cross-intolerance to NSAIDs and good tolerance to paracetamol. Etoricoxib was administered to Group A patients and to a representative sample of Group B patients. In the event of a positive response, serum tryptase levels were determined and skin biopsy was performed in five patients in each group. RESULTS Ibuprofen was the most commonly implicated drug, followed by acetylsalicylic acid (ASA). Urticaria was the most common manifestation, followed by angioedema. Most of the patients developed symptoms within 1 h. Twenty-five percent in Group A (n = 47) and 6% in Group B (n = 50) were intolerant to etoricoxib. Skin biopsy showed mast cell activation with the release of tryptase to the extracellular space but without the increase in serum tryptase levels. CONCLUSION Selective COX-2 inhibitors may be unsafe in subjects with urticaria and/or angioedema caused by hypersensitivity reactions to NSAIDs with cross-intolerance if they are intolerant to paracetamol. A quarter of patients who were intolerant to this drug were also intolerant to etoricoxib. In subjects with hypersensitivity to NSAIDs and intolerance to paracetamol, selective COX-2 inhibitors should be administered as a controlled, incremental dose provocation test to assess tolerance.
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Affiliation(s)
- I Doña
- Allergy Service, Carlos Haya Hospital, Málaga, Spain
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Doña I, Blanca-López N, Cornejo-García JA, Torres MJ, Laguna JJ, Fernández J, Rosado A, Rondón C, Campo P, Agúndez JA, Blanca M, Canto G. Characteristics of subjects experiencing hypersensitivity to non-steroidal anti-inflammatory drugs: patterns of response. Clin Exp Allergy 2011; 41:86-95. [PMID: 21155908 DOI: 10.1111/j.1365-2222.2010.03651.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently involved groups of medicines in hypersensitivity drug reactions. Two mechanisms can induce the reaction: immunological (sensitization) due to a specific IgE or T cell response and pharmacological (cyclooxygenase inhibition). The contribution of each of these mechanisms to the reactions is not well known. OBJECTIVE To analyse a large group of subjects with confirmed hypersensitivity reactions to NSAIDs. METHODS The drugs involved, the clinical entities induced and the time interval between drug intake and appearance of the reaction were studied. In cases where the diagnosis was not confirmed, a drug provocation test was carried out. Atopy status was also assessed with prick test and total IgE in serum. RESULTS A total of 659 patients were finally considered to have had hypersensitivity reactions to NSAIDs; 76% had cross-intolerance (CI) and 24% were selective responders (SR). The most important drugs involved in CI were propionic acid derivatives, in most cases ibuprofen, and in SR pyrazolones. In CI, the most frequent clinical entity was urticaria and angio-oedema and to a lesser extent airway involvement. The skin and airways were both involved in an important proportion of cases. The most frequent entities in SR were urticaria and/or angio-oedema followed by anaphylaxis. Atopy was significantly associated in the CI group (P<0.005). CONCLUSION AND CLINICAL RELEVANCE Cutaneous hypersensitivity reactions by CI to NSAIDs are the most frequent entities induced by these compounds. In addition to aspirin, other NSAIDs are taking on a predominant role. Atopy can be a predisposing factor in patients with CI.
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Affiliation(s)
- I Doña
- Allergy Service, Carlos Haya Hospital (Pabellon C), Málaga, Spain
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Rojas P, Sánchez L, Santos A, Góõmez MP, Blanco H, Laguna JJ. Hypersensitivity to repaglinide. J Investig Allergol Clin Immunol 2011; 21:245-247. [PMID: 21548456] [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: 05/30/2023] Open
Abstract
Meglitinides (repaglinide and nateglinide) are insulin secretagogues used to treat diabetes mellitus. We present a case of hypersensitivity reaction to repaglinide in a 61-year-old man who developed a maculopapular rash 5 days after treatment. Skin prick tests including repaglinide (0.5 g/mL) and patch tests (0.05% in pet and saline) were performed, and the results were negative. A blind oral challenge test with repaglinide was performed and the therapeutic dose was subsequently taken at home every 24 hours for 7 days. The result was positive with a delayed reaction at day 3. A punch biopsy of the skin lesions revealed drug-induced exanthema. The clinical manifestations, the latency period, the reappearance of cutaneous lesions after rechallenge, and the histopathology report of the skin biopsy suggest a type IV mechanism.
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Affiliation(s)
- P Rojas
- Allergy Unit, Hospital Central de la Cruz Roja, Madrid, Spain.
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Torres MJ, Ariza A, Fernández J, Moreno E, Laguna JJ, Montañez MI, Ruiz-Sanchez AJ, Blanca M. Role of minor determinants of amoxicillin in the diagnosis of immediate allergic reactions to amoxicillin. Allergy 2010; 65:590-6. [PMID: 19968633 DOI: 10.1111/j.1398-9995.2009.02245.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [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: 11/26/2022]
Abstract
BACKGROUND Skin testing of subjects with immediate hypersensitivity to amoxicillin is performed using major and minor determinants of benzylpenicillin plus amoxicillin. However, sensitivity is not optimal, and other determinants need to be considered. We assessed the sensitivity of stable, well-characterized minor determinants of amoxicillin in subjects with immediate allergic reactions to amoxicillin to improve skin test sensitivity. METHODS Amoxicillin, amoxicilloic acid, and diketopiperazine were prepared and characterized by reverse-phase HPLC, tested in vivo by skin testing and in vitro by basophil activation test and RAST inhibition assay. RESULTS Patients with immediate hypersensitivity to amoxicillin were selected: Group A (n = 32), skin test positive just to amoxicillin; Group B (n = 19), skin test positive to benzylpenicillin determinants; Group C (n = 10), skin test negative and amoxicillin drug provocation test positive. In Group A, 27 subjects (81.8%) were skin test positive to amoxicillin, ten (30.3%) to amoxicilloic acid, two (6.1%) to diketopiperacine, and six (18.2%) negative. In Group B, nine (50%) were positive to amoxicillin, eight (42.1%) to amoxicilloic acid, none to diketopiperacine, and nine (50%) negative. In Group C, skin tests were negative. BAT was positive to amoxicillin in 26 patients (50.9%), to amoxicilloic acid in 15 (29.1%), and diketopiperazine in four (7.8%). RAST inhibition studies showed > 50% inhibition in all sera, with the highest concentration of amoxicillin and amoxicilloic acid. CONCLUSIONS The combination of minor determinants of amoxicillin, amoxicilloic acid, and diketopiperazine seems to be of no greater value than the use of amoxicillin alone. Further efforts are needed to find new structures to improve sensitivity in the diagnosis of immediate hypersensitivity to betalactams.
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