Drug Allergy

Dapsone, a synthetic sulfone antibiotic with both antimicrobial and anti-inflammatory properties, remains a cornerstone in the treatment of leprosy and dermatitis herpetiformis. Initially investigated in 1937 and first clinically used in leprosy therapy in 1945, dapsone has since expanded to treat a wide range of dermatologic and systemic conditions. The drug’s bacteriostatic effect derives from inhibition of bacterial folic acid synthesis, while its anti-inflammatory activity is mediated primarily through modulation of neutrophil, eosinophil, and monocyte function. Dapsone is available in oral and topical formulations and is incorporated into multidrug regimens, particularly for leprosy. Although generally effective, dapsone can cause significant adverse effects, including hemolytic anemia, methemoglobinemia, peripheral neuropathy, and hypersensitivity reactions. Special populations, such as patients with G6PD deficiency, pregnant women, or those with hepatic or renal impairment, require careful risk-benefit assessment and monitoring. Optimal patient outcomes are achieved through an interprofessional healthcare approach involving physicians, pharmacists, nurses, and specialists, emphasizing patient education, vigilant monitoring, and timely intervention for adverse events. This review elaborates the pharmacokinetics, mechanisms of action, indications, adverse effect profile, contraindications, and clinical monitoring strategies pertinent to dapsone therapy.

Following the first description of hypersensitivity reaction to aspirin (ASA) by Hirschberg in 1902, several types of hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) have been described. The NSAIDs-induced hypersensitivity reactions involve different mechanisms and present a wide range of clinical manifestations from anaphylaxis

Background: Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population. Methods: For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays. Results: One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions. Conclusions: We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.

Background: Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population. Methods: For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays. Results: One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions. Conclusions: We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.

Suspected perioperative allergic reactions are often severe. To avoid potentially life-threatening re-exposure to the culprit drug, establishing a firm diagnosis and identifying the culprit is crucial. Drug provocation tests are considered the gold standard in drug allergy investigation but have not been recommended in the investigation of perioperative allergy, mainly because of the pharmacological effects of drugs such as induction agents and neuromuscular blocking agents. Some specialised centres have reported benefits of provocation testing in perioperative allergy investigation, but the literature on the subject is limited. Here we provide a status update on the use of drug provocation testing in perioperative allergy, including its use in specific drug groups. This review is based on a literature search and experiences of the authors comprising anaesthesiologists and allergists with experience in perioperative allergy investigation. In addition, 19 participating centres in the International Suspected Perioperative Allergic Reaction Group were surveyed on the use of provocation testing in perioperative allergy investigation. A response was received from 13 centres in eight European countries, New Zealand, and the USA. Also, 21 centres from the Australian and New Zealand Anaesthetic Allergy Group were surveyed. Two centres performed provocation routinely and seven centres performed no provocations at all. Nearly half of the centres reported performing provocations with induction agents and neuromuscular blocking agents. Drug provocation testing is being used in perioperative allergy investigation in specialised centres, but collaborations between relevant specialties and multicentre studies are necessary to determine indications and establish common testing protocols.

Perioperative immediate hypersensitivity reactions are rare. Subsequent allergy investigation is complicated by multiple simultaneous drug exposures, the use of drugs with potent effects and the many differential diagnoses to hypersensitivity in the perioperative setting. The approach to the investigation of these complex reactions is not standardized, and it is becoming increasingly apparent that collaboration between experts in the field of allergy/immunology/dermatology and anaesthesiology is needed to provide the best possible care for these patients. The EAACI task force behind this position paper has therefore combined the expertise of allergists, immunologists and anaesthesiologists. The aims of this position paper were to provide recommendations for the investigation of immediate‐type perioperative hypersensitivity reactions and to provide practical information that can assist clinicians in planning and carrying out investigations.

Despite their low frequency, drug hypersensitivity reactions (DHRs) can be serious and result in lifelong sequelae. The diagnosis is critical to avert future reactions and should identify the culprit drug or drugs and safe alternatives. However, making the diagnosis can be complex and challenging. Reliable in vitro tests can offer the potential to improve a diagnosis of DHR and influence medical decision making. Importantly, in vitro testing is frequently not performed as a test in isolation but rather as a component of a diagnostic algorithm along with additional tests. There are several in vitro approaches for the different endotypes of DHRs. However, only few are available for routine diagnosis, and many are restricted to research laboratories. In vitro tests exhibit varying sensitivity and specificity depending on the drug involved and the clinical phenotype. In vitro tests can complement skin tests, especially in patients with negative or equivocal skin test responses inconsistent with the clinical presentation and in severe reactions in which drug provocation tests are contraindicated. The main unmet need for many in vitro tests for the diagnosis of DHRs is validation in larger studies with standardized controls that could harmonize diagnostic management between the United States, European Union, and other regions of the world.

Background: Hypersensitivity reactions to anaesthetic agents are rare but often severe, with a mortality ranging from 4 to 9% in IgE-mediated events. Identification of the risk factors may contribute to limit the incidence of these reactions. The aim of our study was to search for possible risk factors of severe perioperative hypersensitivity reactions in our study population. Methods: For this study we retrospectively reviewed data from 193 patients who experienced drug hypersensitivity reactions during general anaesthesia. The diagnostic protocol consisted of 1) history of the reaction, 2) measurement of serum baseline tryptase and specific IgE-assays for latex, beta-lactams and succinylcholine, 3) skin tests for the agents listed in the anaesthesia chart and for others likely to be safe for future use, latex, and others medications administered during the perioperative period (i.e. antibiotics), 4) subdivision of our patients on the basis of two criteria: a) grade of severity of clinical reactions according to the Ring and Messmer classification; b) results of skin tests and/or serum specific IgE-assays. Results: One hundred of 193 patients had reactions of grade I, 32/193 patients had reactions of grade II, 55/193 patients had reactions of grade III and 6/193 patients had reactions of grade IV. A diagnosis of IgE-mediated reaction was established in 55 cases (28.50%); the most common causes were neuromuscular blocking agents, followed by latex and beta-lactams. Severe reactions were associated with older age (p = 0.025), asthma (p = 0.042), history of hypertension (p = 0.001), intake of serum angiotensin converting enzyme inhibitor medication (p = 0.012) or serum angiotensin II antagonist (p = 0.033), higher levels of basal tryptase (p = 0.0211). Cardiovascular symptoms (p = 0.006) and history of hypersensitivity to antibiotics (p = 0.029) were more frequently reported in IgE-mediated reactions. Conclusions: We confirmed the relevance of several clinical features as risk factors for anaphylactic reactions induced by anaesthetic agents: older age, asthma, hypertension and antihypertensive drugs. We observed increased levels of serum basal tryptase in severe reactions: this finding may signify that this biomarker is useful for the identification of patients at risk.

The aim of the study was to perform a retrospective analysis of the morbidity of patients with allergic reactions hospitalized in the department of oral and maxillofacial surgery of the Institute of Emergency Medicine in Chisinau during 2015—2019. To achieve the aim, the medical records of 263 patients, hospitalized during the evaluated period, were studied. It was revealed that the frequency of patients with drug allergies accounted for 3% of the total number of patients hospitalized in the department of oral and maxillofacial surgery during 2015—2019. The analysis of statistical data found an increased incidence of drug allergy in women, most of them with various chronic diseases and allergy to a single drug. A higher frequency of hypersensitivity to local anesthetics was recorded in the group of amidine derivatives (72%).

RATIONALE: Skin tests (ST) are useful in identifying patients with immediate-type hypersensitivity to platinum chemotherapeutics. We investigated the outcomes of induction of tolerance (IOT) procedures in relation to platinum ST results. METHODS: An IRB approved, seven year retrospective review of patients evaluated for platinum-based reactions was conducted. Data gathered for statistical analysis included index reaction details as well as ST results and IOT outcomes. RESULTS: Platinum reactions were identified in 36 patients (88.9% female; age 63.6+10.1 years; n534 carboplatinum, n52 oxaliplatin) who underwent a total of 146 IOTs. Most index reactions (72.2%) were non-anaphylactic. Platinum ST (skin prick +/-intra-dermal) were performed (median 14 days) after the index reaction. The initial ST results (positive-negative-equivocal) comprised: (8-6-1) for completely IOT-tolerant patients (n515) and (9-10-2) for patients who reacted during any IOT (n521). Equivocal-ST patients were less likely to experience IOT reactions (OR50.28, 95% CI:0.10-0.78; p50.015). The conversion rate to positive was 63.6% (n57/11; repeat ST 1-26 months after index reaction). All patients with index reactions of anaphylaxis or respiratory arrest converted to positive on repeat ST. IOT reaction rates were as follows: ST-non-converters (35.3%), STconverters (31.7%), and initial positive-ST patients (29.9%). Of all patients, 24/36 displayed positive ST and 96.6% of all IOTs were completed. CONCLUSIONS: Initial and repeat ST results did not predict IOT outcomes in our population. Initial equivocal-ST patients exhibited a decreased risk for IOT reaction and all patients with severe systemic reactions converted to positive on repeat ST. Nearly all IOTs were completed, allowing patients to receive additional platinum courses.

Introduction: Nasobronchial allergy remains a substantial public health concern in India. In this part of North India (Garhwal), data on allergen sensitivity patterns are limited. This study aimed to identify the pattern of aeroallergen sensitivity among patients with nasobronchial allergies. Materials and methods: This retrospective descriptive study was conducted in a tertiary care center between January 2021 and December 2024. A total of 150 patients, aged 15–50 years, who were diagnosed with allergic rhinitis or asthma based on ARIA and GINA guidelines, underwent a skin prick test. The results of the positive prick test were analyzed among study participants. Results: The maximum allergen sensitivity pattern was seen in the house dust mite group (40.4%), followed by the insect group (22.7%) and the food allergen group (17.46%). In the house dust mite group, D. farinae (44%) and D. pteronyssinus (43.3%) were the most common allergens. In the insect group, the majority were allergic to cockroaches (36%), followed by mosquitoes, house flies, rice weevils, and moths. Likewise, in food allergens, most were sensitive to wheat (25.3%). Conclusions: Correctly identifying the aeroallergen positivity in a geographical area might help in the appropriate selection of a panel of allergens for testing, measures for allergen avoidance, and immunotherapy.

Omeprazole is a proton pump inhibition and ranitidine is an H2 histamine receptor antagonist widely used in the treatment of gastroesophageal reflex disease, peptic ulcer disease, Zollinger-Ellison syndrome and as a protector of the gastric mucosae. We report a case of occupational contact allergy to omeprazole and ranitidine. A 48-year-old man, with no pre-existing history of atopy or lifestyle factors. He neither had any medical history of consumption of drugs such as ranitidine and omeprazole. He worked for 19 months in the pharmaceutical company that manufactured ranitidine base. He presented rash in the face and eczema on the dorsum of the hands with itching. The study by prick tests with ranitidine gave negative response. Patch testing with ranitidine base and ranitidine hydrochloride gave positive response. A month later, when the patient was asymptomatic he returned to the pharmaceutical company, being switched from this previous job to the reactor manufacturing omeprazole. A few days after that, he presented with erythematous eruptions involving face and neck with itching. Prick tests, path tests and in vitro laboratories studies with omeprazole gave positives. In this case the patient presented hypersensitivity type I at omeprazole and hypersensitivity type IV at omeprazole and ranitidine. Our aportation indicates the importance of careful analysis of the occupational exposure histories of patients with the suspected type I or type IV hypersensitivity to allergens, to determine whether work exposure is the cause. Med Pr 2017;68(3)

Topical antibiotics are frequently introduced in therapy by various specialists, e.g., dermatologists-venereologists, ENT specialists, proctologists, ophthalmologists, and others. In dermatology, topical antibiotics are used in the treatment of superficial inflammatory skin lesions, acne and rosacea. These agents are also used in the prevention of inflammatory lesions after surgical and corrective procedures. Long-term and uncontrolled application of topical antibiotics, on the skin with impaired protective barrier in particular, implies a risk for the development of hypersensitivity to these agents. Considering the very wide utilization of these agents, hypersensitivity to topical antibiotics poses a major problem worldwide. The groups at a high risk of contact sensitivity to topical antibiotics include patients with chronic venous insufficiency, chronic ulcers and chronic otitis externa, as well as individuals at occupational exposure to antibiotics, e.g., human medicine and veter...

Background: Beta-lactams antibiotics (BL) are the most frequent elicitors of allergic drug reactions. The aim of our study was to characterize the patients referred with suspected hypersensitivity (HS) to BL. Methods: Over a three-year period (2011-2013), a total of 234 adult and paediatric patients (pts) with suspected HS to BL were investigated according to the European Network for Drug Allergy guidelines. Results: HS to BL was confirmed in 43 pts (18%), without differences between adult and paediatric pts; anaphylaxis was reported by 20 pts. Diagnosis was ascertained by: serum-specific IgE antibodies in 5 pts (12%), skin prick tests in 5 (12%), intradermal tests in 25 (58%), 3 with delayed reading, and the remaining 8 (18%) by drug provocation tests. Penicillins / derivatives were the culprit drugs in 39 pts, mainly amoxicillin, and cephalosporins in 4. Conclusion: In most of these patients with suspected HS to BL, allergological work-up was negative and HS was excluded. One fourth of confirmed cases had a plausible non-IgE mediated mechanism.

Metamizol is a pyrazolone-derivative nonsteroidal anti-inflammatory drug that is commonly associated with hypersensitivity reactions. Some of these reactions are IgE-mediated and potentially severe, which limits the diagnosis based on oral drug challenge. We describe 6 selective metamizol hypersensitivity cases, regarding clinical evaluation and diagnosis management, with focus on the usefulness of skin tests and the cellular allergen stimulation test (CAST). All patients were female, aged 27 to 50 years old. All had immediate reactions after metamizol administration: 3 had anaphylaxis and 3 had urticaria and angioedema. Skin prick tests with metamizol were positive in 2 patients. Intradermal tests were positive in the remaining, all with 1/100 dilution, and elicited systemic reactions in 2 of them. CAST to metamizol was negative in all cases. The patients tolerated other nonsteroidal anti-inflammatory drugs. Skin tests proved to be a good diagnostic method to identify IgE-mediated ...

Epidemiologic drug allergy data from Latin America are scarce, and there are no studies on specific procedures focusing on this topic in Latin America. To assess the clinical characteristics and management of hypersensitivity drug reactions in different Latin American countries. An European Network of Drug Allergy questionnaire survey was implemented in 22 allergy units in 11 Latin American countries to report on consecutive patients who presented with a suspected hypersensitivity drug reaction. Each unit used its own protocols to investigate patients. Included were 868 hypersensitivity drug reactions in 862 patients (71% of adults and elderly patients were women and 51% of children were girls, P = .0001). Children presented with less severe reactions than adults and elderly patients (P < .0001). Urticaria and angioedema accounted for the most frequent clinical presentations (71%), whereas anaphylaxis was present in 27.3% of cases. There were no deaths reported. Nonsteroidal anti...

Background: Drug challenge tests serve to evaluate whether a patient is allergic to a medication. However, the allergy list in the electronic health record (EHR) is not consistently updated to reflect the results of the challenge, affecting clinicians' prescription decisions and contributing to inaccurate allergy labels, inappropriate drug-allergy alerts, and potentially ineffective, more toxic, and/or costly care. In this study, we used natural language processing (NLP) to automatically detect discrepancies between the EHR allergy list and drug challenge test results and to inform the clinical recommendations provided in a real-time allergy reconciliation module. Methods: This study included patients who received drug challenge tests at the Mass General Brigham (MGB) Healthcare System between June 9, 2015 and January 5, 2022. At MGB, drug challenge tests are performed in allergy/immunology encounters with routine clinical documentation in notes and flowsheets. We developed a rule-based NLP tool to analyze and interpret the challenge test results. We compared these results against EHR allergy lists to detect potential discrepancies in allergy documentation and form a recommendation for reconciliation if a discrepancy was identified. To evaluate the capability of our tool in identifying discrepancies, we calculated the percentage of challenge test results that were not updated and the precision of the NLP algorithm for 200 randomly sampled encounters. Results: Among 200 samples from 5,312 drug challenge tests, 59% challenged penicillin reactivity and 99% were negative. 42.0%, 61.5%, and 76.0% of the results were confirmed by flowsheets, NLP, or both, respectively. The precision of the NLP algorithm was 96.1%. Seven percent of patient allergy lists were not updated based on drug challenge test results. Flowsheets alone were used to identify 2.0% of these discrepancies, and NLP alone detected 5.0% of these discrepancies. Because challenge test results can be recorded in both flowsheets and clinical notes, the combined use of NLP and flowsheets can reliably detect 5.5% of discrepancies. This NLP-based tool may be able to advance global delabeling efforts and the effectiveness of drug allergy assessments. In the real-time EHR environment, it can be used to examine patient allergy lists and identify drug allergy label discrepancies, mitigating patient risks.

BackgroundDrug challenge tests serve to evaluate whether a patient is allergic to a medication. However, the allergy list in the electronic health record (EHR) is not consistently updated to reflect the results of the challenge, affecting clinicians' prescription decisions and contributing to inaccurate allergy labels, inappropriate drug-allergy alerts, and potentially ineffective, more toxic, and/or costly care. In this study, we used natural language processing (NLP) to automatically detect discrepancies between the EHR allergy list and drug challenge test results and to inform the clinical recommendations provided in a real-time allergy reconciliation module.MethodsThis study included patients who received drug challenge tests at the Mass General Brigham (MGB) Healthcare System between June 9, 2015 and January 5, 2022. At MGB, drug challenge tests are performed in allergy/immunology encounters with routine clinical documentation in notes and flowsheets. We developed a rule-ba...

Background: Drug provocation tests (DPTs) are the gold standard in the diagnosis of b-lactam hypersensitivity. However, no consensus exists on the need for extended provocation tests, even though the effectiveness of the short DPT is relatively low and there has been an increase in the relative incidence of nonimmediate hypersensitivity reactions. Objective: To evaluate the effectiveness of a 7-day (extended) DPT compared with a 1-day-only (short) DPT in the management of hypersensitivity reactions to b-lactam antibiotics. Methods: Patients referred to the allergy clinic of the Sheba Medical Center for suspected b-lactam hypersensitivity from January 2008 to December 2012 underwent in vivo skin tests and an immediate short DPT with the culprit drug. Unless an immediate reaction was clearly documented, patients were offered a 7-day, extended DPT. Long-term effectiveness, calculated as the subsequent use of the tested antibiotic, and satisfaction levels were assessed with a telephone questionnaire. Results: Of 49 negative DPT results, 26 (53%) were long and 23 (47%) were short. A total of 78% of the patients who underwent the long DPT reported that they used the drug compared with 61% of those who underwent only the short DPT (P ¼ .049). Most patients were very satisfied with the drug allergy evaluation process. Conclusions: An extended DPT protocol increased the effectiveness of the allergy workup in our center without compromising patient satisfaction and safety, and it should be recommended to patients with a history of nonimmediate reaction to b-lactam.

Background: The published incidence of paracetamol cross-reactivity in adults and adolescents with nonsteroidal anti-inflammatory drug (NSAID) reactions is low and all data on such reactions in young children is sparse. The study aim was to characterize the clinical presentation and cross-reactivity with paracetamol in patients with a reported onset of NSAID hypersensitivity before 6 years of age. Methods: A retrospective case review was done of patients with cross-reactive hypersensitivity reactions to antipyretic/analgesic medications from the pediatric allergy clinic of the Kendang Kerbau Hospital, Singapore. Included patients reported the onset of such reactions before 6 years of age. Hypersensitivity was established through a detailed history of recurrent reactions to NSAIDs or an oral provocation test. Results: Eighteen patients fulfilled the diagnostic criteria within the study period. Eighty-three percent had cross-reactive reactions with paracetamol. When compared to the gr...

Background & Aims: Serum sickness is a type 3 hypersensitivity reaction caused by the injection of foreign proteins, serums, and nonprotein medications. This study investigated the demographic, clinical, and laboratory characteristics, along with outcomes, of patients with serum sickness hospitalized at Shahid Motahari Hospital, Urmia, from March 2017 to February 2021. Materials & Methods: This descriptive cross-sectional study included 67 patients diagnosed with serum sickness based on a recent history of exposure to an antigenic substance. Demographic, clinical, paraclinical data, and disease outcomes-including hospital stay length, ICU admission history, treatment response, mortality, and information regarding the potential cause of the disease-were collected from patient records, recorded in a checklist, and analyzed using SPSS statistical software version 22. Results: Arthralgia was present in 20 patients (29.9%), gastrointestinal complaints in nine children (13.4%), headaches in eight children (11.9%), muscle pain in 18 children (26.9%), arthritis in 14 children (20.9%), and urinary symptoms in one child (1.5%). The most frequent cause of serum sickness was phenobarbital, identified in 26 patients (38.8%), followed by cefixime in nine patients (13.4%), azithromycin in six patients (9%), ceftriaxone in five patients (7.5%), and co-amoxiclav in four patients (6%). Additionally, leukocytosis was found in 23 patients (34.3%), 32 patients (47.8%) had a positive C-reactive protein (CRP), 32 patients (47.8%) had an elevated erythrocyte sedimentation rate (ESR), same as sedimentation rate, and elevated aspartate aminotransferase (AST) and alanine transaminase (ALT) were detected in 4 patients (6%) each. Conclusion: Clinically, serum sickness was most commonly associated with fever, skin rashes, muscle pain, and changes in paraclinical findings in patients.

Background: Drug allergy, or drug hypersensitivity, is a potentially fatal disorder, and patients labeled with drug allergies have restricted access to first-line treatments. Full knowledge of the characteristics associated with drug allergies and severe reactions during allergy evaluation is beneficial for appropriate risk stratification. Objective: We sought to determine whether certain clinical characteristics are associated with drug allergies in Chinese children. Charts were reviewed for ethnic Chinese patients less than 18 years old referred to our tertiary allergy center for suspected drug allergies and completed skin and drug provocative testing between 2005 to 2017. Univariate and multivariate analyses were performed on the age of onset of drug allergies, gender, and other atopy versus drug allergies. Results: Out of 75 children, 18 (24%) had IgE-mediated drug allergies, while 8 (10.7%) had delayed drug hypersensitivities, with a cumulative 26 subjects (34.7%) with any drug hypersensitivity. There were positive independent associations between drug hypersensitivities onset age vs IgE-mediated drug allergies (odds ratio (OR) = 14.9, 95% confidence intervals (CIs) = 1.5-148.3, P = 0.017) and between male gender and IgE-mediated drug allergies (OR = 4.4, CIs = 1.2-16.4, P = 0.019). Age 13 years was the best cut-off for IgE-mediated drug allergies according to the receiver operating characteristic curve (P = 0.026). Older age group (OR = 24.0, CIs = 1.4-417.8, P = 0.024) and atopic dermatitis (OR = 8.2, CIs = 1.4-49.8, P = 0.015) were correlated with delayed drug hypersensitivities. While several previous studies suggested a higher prevalence of IgE-mediated drug allergies in younger adult females, older boys were more likely to have drug allergies for Chinese children.

History of drug allergy is of major concern during perioperative period. Medical records usually lack documents confirming the stated allergy. This study aimed to investigate the prevalence of self-reported drug allergies and their characteristics in adult Serbian surgical population, and to analyze their influence on drug prescription during perioperative period. The study enrolled patients scheduled for general surgery during a one-year period at a tertiary care hospital. They were questioned using a structured questionnaire about the existence of drug allergy and its nature. Medical records were examined after discharge to assess medical prescription during hospitalization. Of 1126 patients evaluated during the study period, 434 (38.5%) reported a total of 635 drug reactions. The most common allergy claim was to antibiotics (68%), nonsteroidal antiinflammatory drugs (16.4%) and iodine (3.9%). Women, urban residents and herbal drug consumers were more likely to state an allergy. T...

The prevalence of allergic reactions in general population shows a constant rise. It has been estimated that up to 40% of surgical patients have a positive history of some kind of allergy. These patients represent a challenge during perioperative evaluation, since they can be exposed to a large variety of drugs and substances during surgery and anesthesia. A lot of adverse drug reactions show similar clinical presentation with allergic reactions. The latter are usually poorly explored since preoperative allergology testing is performed in a limited number of patients. Management of patients with history of allergy is impeded by the fact that most of allergens cross-react in a manner that is not always easy to predict. Allergies can manifest themselves with a broad spectrum of clinical symptoms, ranging from mild skin symptoms such as itch and urticaria, to a life-threatening anaphylactic reactions followed by hypotension, bronchospasm and cardiovascular collapse. Prevention of aller...

Electronic health records (EHRs) are used to register important health-related information, such as allergic conditions, and contribute to the safety and quality of medical care. To evaluate the use of allergy alert entries in EHRs and to establish the allergy profile of hospitalized patients. Allergy data recorded in EHRs were analyzed in a cross-sectional, observational, descriptive study of patients admitted to the hospital from January 1 through June 30, 2011. A total of 15,534 patients were admitted to the hospital during the study period. The rate of inclusion of allergy information in the EHRs was 64.4%. In 2,106 patients an alert was activated to declare an allergy, intolerance, or any other type of adverse reaction. Drugs were the most common responsible agent (74.4%), followed by foods (12.6%) and materials (4.8%). Entries for drug allergy or intolerance were more common in females (64.8%) than males, with a significant statistical difference (P < .01), and increased pr...

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used throughout the world. They are frequently involved in hypersensitivity reactions, which range from local or mild reactions to systemic and severe reactions. Consequently, it is necessary to perform an exhaustive study of patients in order to make an accurate diagnosis, search for safe procedures in the case of severe reactions, and identify alternative treatment options. Various guidelines and protocols address the management of hypersensitivity to NSAIDs, although these vary widely from country to country. The Committees of Asthma, Rhinoconjunctivitis, and Drug Allergy of the Spanish Society of Allergy and Clinical Immunology (SEAIC) propose the present position statement on available options for challenge testing with aspirin/NSAIDs. This document is the fruit of an exhaustive review of current evidence and is based on recent publications addressing the diagnosis of patients with hypersensitivity to NSAIDs and on a consensus-oriented discussion among a group of experts from the SEAIC. The main objective has been to draft an easy-to-read, practical guideline for health care professionals in specialist areas who assess and manage patients with suspected hypersensitivity to NSAIDs. Furthermore, indications, contraindications, and procedures for oral, bronchial, and nasal provocation tests with aspirin/NSAIDs have been updated.

Recurrent Aphthous Stomatitis (RAS) adalah kondisi inflamasi kronis berulang di mukosa mulut yang ditandai dengan munculnya ulkus superfisial nyeri, berbatas tegas, dan dikelilingi area eritema. Meskipun penyebab pasti RAS belum diketahui, bukti klinis dan epidemiologis menunjukkan hubungan signifikan antara RAS dan alergi makanan. Reaksi imun terhadap protein makanan tertentu dapat memicu lesi aftosa, terutama pada individu yang mengalami sensitisasi terhadap susu sapi, telur, gandum, dan makanan laut. Pendekatan diagnosis melalui eliminasi makanan dan oral food challenge (OFC) menunjukkan peran penting alergi makanan dalam patogenesis RAS. Artikel ini bertujuan mengeksplorasi hubungan imunopatogenetik dan klinis antara RAS dan alergi makanan, serta mendiskusikan strategi penanganan berbasis eliminasi makanan dan OFC.

Alergi makanan telah diakui sebagai faktor yang berpotensi berkontribusi pada berbagai kelainan saluran napas atas, termasuk hipertrofi adenoid pada anak-anak. Hipertrofi adenoid dapat memperburuk gangguan pernapasan dan meningkatkan risiko infeksi telinga berulang. Penanganan alergi makanan yang tepat, termasuk dengan pendekatan oral food challenge (OFC), lebih akurat dibandingkan pemeriksaan laboratorium serologi seperti tes panel IgE spesifik. Penggunaan obat antialergi hanya memberikan perbaikan gejala sementara tanpa mengatasi penyebab dasar. Pemahaman hubungan ini sangat penting untuk diagnosis dan terapi yang lebih efektif.

Background: Hypersensitivity to acetylsalicylic acid (ASA) constitutes a serious problem for subjects with coronary artery disease. In such subjects, physicians have to choose the more appropriate procedure between challenge and desensitization. As the literature on this issue is sparse, the present study aims to establish in these subjects clinical criteria for eligibility for an ASA challenge and/or desensitization. Collection and analysis of data on ASA challenges and desensitizations from 10 allergy centers, as well as consensus among the related physicians and an expert panel. Results: Altogether, 310 subjects were assessed; 217 had histories of urticaria/angioedema, 50 of anaphylaxis, 26 of non-immediate cutaneous eruptions, and 17 of bronchospasm related to ASA/NSAID intake. Specifically, 119 subjects had index reactions to ASA doses lower than 300 mg.

H ypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is one of the most common drug related adverse reactions in children. 1,2 Classification of NSAID hypersensitivity is based on the presence of cross-reactivity, the clinical manifestations and the presence of an underlying disease. According to the mentioned criteria, five major clinical phenotypes of can be differentiated. However, all patients with NSAID hypersensitivity may not fit into this classification. Therefore, advanced phenotyping within these major groups is thought to be possible with better characterization of clinical features of patients.

Introduction: The drug allergy alert system reduces the frequency of adverse drug events, although it is subjected to collateral effects, since 80–90% of alerts are not real, and a large percentage of alerts are overridden (46.2–96.2%). We reviewed how the alert system is used at University Hospital Fundación Alcorcon (HUFA). Methods: Data were obtained from the drug allergy alert and the alert overriding notification forms (both in the period 2011–20). We also recorded drug allergy diagnoses at HUFA, drug consumption in primary care in 2016. We calculated the incidence of drug allergy alert activation, temporal trends in use, and correlations between the number of drugs in several datasets. Results: We collected 15,535 alerts. NSAIDs and penicillins were the drugs with the highest number of drug allergy alerts (36.55% and 26.91%, respectively). A correlation was found between the number of drug alerts and the type of drug allergy in HUFA in 2016. Only 6.83% of the alerts were remov...

Hypersensitivity reactions to drugs account for 15% of all adverse drug reactions and represent an important health problem with significant morbidity and mortality. This article describes the current applications and perspectives of the basophil activation test by flow cytometry in the diagnosis of immediate-type drug allergy, with particular focus on its diagnostic performance in allergy to neuromuscular blocking agents, antibiotics and NSAIDs and on future applications.

Anaphylactic reactions to anaesthetic and associated agents used during the perioperative period have been reported with increasing frequency in most developed countries. Any drug administered in the perioperative period can potentially produce life-threatening immune-mediated anaphylaxis. Most published reports on the incidence of anaphylaxis come from France, Australia, the UK and New Zealand. These reflect an active policy of systematic clinical and/or laboratory investigation of suspected immune-mediated reactions. The estimated incidence of anaphylaxis ranges from 1 : 10 000 to 1 : 20 000. Muscle relaxants (69.1%) and latex (12.1%) were the most frequently involved drugs according to the most recent French epidemiological survey. Clinical symptoms do not afford an easy distinction between immune-mediated anaphylactic reactions and anaphylactoid reactions resulting from direct non-specific histamine release. Moreover, when restricted to a single clinical symptom, anaphylaxis can easily be misdiagnosed. Pre-and postoperative investigation must be performed to confirm the nature of the reaction, the responsibility of the suspected drugs and to provide precise recommendations for future anaesthetic procedures. These include plasma histamine, tryptase and specific IgE concentration determination at the time of the reaction and at skin tests 6 weeks later. In addition, since no specific treatment has been shown reliably to prevent the occurrence of anaphylaxis, allergy assessment must be performed in all high-risk patients. Treatment of anaphylaxis is aimed at interrupting contact with the responsible antigen, inhibiting mediator production and release, and modulating the effects of released mediators. It must be initiated as quickly as possible and relies on widely accepted principles. Finally, the need for proper epidemiological studies and the relative complexity of allergy investigation should be underscored. They represent an incentive for further development of allergo-anaesthesiology clinical networks to provide expert advice for anaesthetists and allergologists.

Diagnosis of drug allergy is not always straight forward for several reasons. First, a broad spectrum of drugs can elicit various immune-mediated diseases with distinct pathomechanism, secondly, although exact epitope identification is not mandatory for clinical diagnosis, the epitope that causes the reaction is frequently unknown, thirdly in vitro or in vivo test results might not be predictive of a clinical situation, and fi nally the gold standard or reference test for diagnosis, the drug challenge, is a complicated and sometimes dangerous endeavour. Upon challenge with specific allergens that cross-link membrane-bound IgE antibodies, basophils upregulate the expression of different activation markers such as CD63 and CD203c. These immunophenotypic alterations can be detected on a single-cell basis by multicolour fl ow cytometry using specifi c monoclonal antibodies in the basophil activation test (BAT). This review intends to summarise our current experience with the BAT in the diagnostic management of immediate-type allergy to drugs and related compounds that are generally (but not always) mediated by drug-specifi c IgE antibodies.

Speculations are rife as to the exact aetiology of Type 1 diabetes mellitus, It is suggested that viruses and other agents precipitate this condition, induce vulnerability and the consequential development of adverse infectious disorders. The disease incidence is increasing exponentially in geographically-determined precincts. It is a chronic, autoimmune metabolic disorder characterized by expansively deranged pancreatic beta-cells, insulin deficiency and hyperglycaemia. Certain environmental elements trigger the autoimmune pathways in genetically susceptible children and adolescents. Globally, diabetes is the most common chronic condition. Studies indicate that comorbidities, syndemics, specific patient status, exclusive treatment modalities, and consistent monitoring of blood glucose levels are critical for type 1 diabetes management. Type 1 diabetes is relatively less common than type 2 diabetes, but it poses greater morbidity and mortality than the latter. Research tends to determine the spatiotemporal variations of the disease, whether its incidence is increasing globally or restricted to a select population, and to estimate the magnitude of the alteration in incidence. Type 1 diabetes can pre-exist and remain undiagnosed in patients. It tends to worsen in comorbid states. Competent objective testing measures are pertinent for evaluation, appropriate and well-timed management of childhood type 1 diabetes for significant improvement in healthcare. Management of the disease using insulin or insulin analogues may induce side effects in the form of acute hypoglycemic episodes, central nervous system derangement, dementia, aggravated morbidity or mortality. Consistent self-monitoring blood glucose (SMBG) tool facilitates adjustments of timely insulin dose. In non-industrialised countries and vulnerable populations, latent constraints have revolved around the choice of, and access to medicinal drugs and high-tech systems in the prime management of type 1 diabetes and its sequelae.

Pregnancy is a particular period in womans life. It accompanies with plenty of adaptation changes include many on skin. Pathological morphofunctional changes form a group of pregnancy-specific dermatoses. The clinical case of bullous pemphigoid of pregnancy is presented in the article. The disease occurs during pregnancy or postpartum period. The incidence is estimated to be approximately 1 in 60,000 pregnancies. Clinically, PG is characterized by intense pruritus and polymorphic skin eruptions. Skin lesions develop including erythematous patches and plaques, followed by urticarial rash and blisters. Diagnosis of the disease is based on the features of the clinical picture, complex data of pathomorphological and immunological research methods, including direct or indirect immunofluorescence, enzyme-linked immunosorbent assay (ELISA), immunohistochemical determination of a fragment of the complement component C4d and determination of serum antibodies to BP180. The most effective trea...

Clonidine is an α2-agonist which is used as a sedative premedication in children. There are conflicting results in the published literature about the effect of clonidine on the incidence of post operative nausea and vomiting (PONV). We therefore decided to evaluate the effect of oral clonidine given preoperatively on the incidence of PONV in children after appendectomy. Sixty children, 5-12 years old, classified as American Society of Anesthesiologists physical status I and II, who were scheduled for appendecectomy were enrolled in this randomized double blinded clinical trial. Patients were randomly assigned into two groups of 30 patients. Patients in clonidine group were given 4 µg.kg -1 clonidine in 20 cc of apple juice and patients in control group were given only 20 cc of apple juice 1 hour before transporting to operating room. The protocol of general anesthesia and postoperative analgesia was the same for two groups. Incidence of PONV and antiemetic usage of patients were ass...

Background: Hypersensitivity to penicillin has been studied worldwide, but data regarding patterns of sensitization in Arabian Gulf countries are scarce. Objective: To describe the patterns of penicillin hypersensitivity during a 6-year study in Kuwait in terms of demographics, type of the culprit drug, in vivo and in vitro allergy testing. Methods: One hundred and twenty-four patients referred to the drug allergy clinic for penicillin allergy were fully evaluated by skin prick and intradermal testing. Drug provocation test was done on patients with negative results. Results: A total of 124 patients were evaluated for penicillin allergy. Mean age was 37.8 (standard deviation, 12.7) years, range from 8 to 74 years. Thirty-nine male (31.5%) and 85 female patients (68.5%) were included. Diagnosis of penicillin allergy was confirmed in 46 patients (37.1%). Among the 44 confirmed allergic patients by skin evaluation we had 15 (34.1%) positive skin prick test, and 29 (65.9%) positive intradermal testing. Among patients with positive skin testing, 47.7% were positive to major determinant benzylpenicilloyl poly-L-lysine, 20.4% to minor determinant mixture, 50.0% to penicillin G and 40.9% to ampicillin; 13.6% of patients were positive to amoxicillin by skin prick test. One patient had a positive radioallergosorbent test and one had a positive challenge test. Conclusion: Penicillin allergy is a common problem with an incidence of about one third in our study subjects.

The author studied a frequency of references to emergency of patients with acute allergic diseases (AAD)
and character of the pre-hospital care at this pathology. Prevalence AAD according to first aid's dates is 21 %. Drug
therapy and pre-hospital management of patients require optimization.

A third-generation cephalosporin antibiotic that is frequently used to treat infections is ceftriaxone. Anaphylaxis is uncommon, although ceftriaxone-related hypersensitivity reactions occur 1%-3% of the time. [1] Anaphylaxis symptoms can vary from a minor skin rash to a life-threatening event. Anaphylaxis is the most severe kind, and it affects various organs. The anesthesiologists may face significant difficulties with such patients. Despite negative intradermal skin testing for ceftriaxone, we report a case of severe anaphylaxis caused by an antibiotic that resulted in anaphylactic shock.