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Journal Der Deutschen Dermatologischen... Nov 2017Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions.... (Review)
Review
Adverse drug reactions of the delayed type rank among the most common dermatoses and are predominantly characterized by exanthematous macular or maculopapular eruptions. However, approximately 2 % of affected individuals develop severe or even life-threatening systemic immune reactions associated with organ involvement, requiring immediate diagnosis and treatment. Numerous drugs are capable of eliciting delayed-type hypersensitivity reactions, with antibiotics, anticonvulsant drugs, and the xanthine oxidase inhibitor allopurinol being the most common. Apart from genetic susceptibility, predisposing factors for the development of drug hypersensitivity reactions include high drug doses, polypharmacy, long treatment duration, female gender, as well as acute or chronic infections.
Topics: Administration, Oral; Administration, Topical; Adrenal Cortex Hormones; Drug Eruptions; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Infusions, Parenteral; Intradermal Tests; Patch Tests; Prescription Drugs; Risk Factors; Virus Diseases
PubMed: 29106000
DOI: 10.1111/ddg.13362 -
Swiss Medical Weekly Feb 2023Corticosteroids, which are anti-inflammatory and immunosuppressive agents used for the treatment of various diseases including allergic disorders, can induce immediate... (Review)
Review
BACKGROUND
Corticosteroids, which are anti-inflammatory and immunosuppressive agents used for the treatment of various diseases including allergic disorders, can induce immediate and delayed hypersensitivity reactions. Although these reactions are not common, due to the wide usage of corticosteroid medications, corticosteroid hypersensitivity reactions are clinically important.
OBJECTIVE
In this review, we summarise the prevalence, pathogenetic mechanism, clinical manifestations, risk factors, diagnostic and therapeutic approach for corticosteroid-induced hypersensitivity reactions.
METHODS
An integrative review of the literature was conducted using PubMed searches (mainly large cohort-based studies) regarding the different aspects of corticosteroid hypersensitivity.
RESULTS
Hypersensitivity reactions to corticosteroids can be immediate or delayed and can follow all modes of corticosteroid administration. Prick and intradermal skin tests are useful diagnostic tools for immediate hypersensitivity reactions, patch tests are useful for delayed hypersensitivity reactions. According to the diagnostic tests an alternative (safe) corticosteroid agent should be administered.
CONCLUSION
Physicians of all medical disciplines should be aware that corticosteroids can cause (paradoxically) immediate or delayed allergic hypersensitivity reactions. The diagnosis of such allergic reactions is challenging since it is often difficult to distinguish between hypersensitivity reactions and deterioration of the basic inflammatory disease (e.g., worsening of asthma or dermatitis). Thus, a high index of suspicion is needed in order to identify the culprit corticosteroid.
Topics: Humans; Prevalence; Drug Hypersensitivity; Adrenal Cortex Hormones; Hypersensitivity, Immediate; Hypersensitivity, Delayed; Skin Tests
PubMed: 36800886
DOI: 10.57187/smw.2023.40025 -
Current Allergy and Asthma Reports Mar 2016Corticosteroids are anti-inflammatory medications used widely to treat allergic inflammation. Although the endocrine and gastrointestinal side effects of corticosteroids... (Review)
Review
Corticosteroids are anti-inflammatory medications used widely to treat allergic inflammation. Although the endocrine and gastrointestinal side effects of corticosteroids have been described, the occurrence of immediate hypersensitivity reactions and delayed contact dermatitis due to corticosteroids remains under-recognized. Hypersensitivity reactions can occur to a corticosteroid itself, or to the additives and vehicles in corticosteroid preparations. Skin testing and oral graded challenge can help confirm the suspected culprit agent in immediate hypersensitivity reactions and help identify an alternative tolerated corticosteroid. Patch testing can help identify the culprit agents in delayed hypersensitivity contact dermatitis. Cross-reactivity patterns have not been observed for immediate hypersensitivity reactions as they have been for delayed contact dermatitis. Sensitization in contact dermatitis exhibits cross-reactivity patterns based on corticosteroid structure. We review the current understanding regarding the clinical presentation, evaluation, and management of immediate and delayed hypersensitivity reactions to corticosteroids.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Skin Tests
PubMed: 26857016
DOI: 10.1007/s11882-016-0596-7 -
Oral Surgery, Oral Medicine, Oral... May 2017Allergic contact stomatitis (ACS) is an oral mucosal immunoinflammatory disorder variably characterized clinically by erythematous plaques, vesiculation, ulceration,... (Review)
Review
Allergic contact stomatitis (ACS) is an oral mucosal immunoinflammatory disorder variably characterized clinically by erythematous plaques, vesiculation, ulceration, and/or hyperkeratosis and by pain, burning sensation, or itchiness. ACS is brought about by a T cell-mediated, delayed hypersensitivity immune reaction generated by a second or subsequent contact exposure of an allergen with the oral mucosa, in a genetically susceptible, sensitized subject. Lichenoid contact reaction is a variant of ACS brought about by direct contact with the oral mucosa of certain metals in dental restorations. The features of ACS are neither clinically nor histopathologically specific, so the diagnosis is usually presumptive and can only be confirmed by resolution of the inflammation after withdrawal or removal of the suspected causative allergen. When ACS is suspected but an allergen cannot be identified, patch testing is necessary. In persistent cases, topical corticosteroids are the treatment of choice, but for severe and extensive lesions, systemic corticosteroid and systemic antihistamines may be indicated. In this short review, we highlight the clinical, immunologic, and histopathological features of ACS, and provide some guidelines for diagnosis and management.
Topics: Dermatitis, Allergic Contact; Humans; Stomatitis
PubMed: 28407984
DOI: 10.1016/j.oooo.2017.02.007 -
British Journal of Clinical Pharmacology Dec 2019Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent... (Review)
Review
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
Topics: Guillain-Barre Syndrome; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Immunocompromised Host; Immunoglobulin E; Skin Tests; T-Lymphocytes; Vaccination; Vaccine Excipients; Vaccines
PubMed: 31472022
DOI: 10.1111/bcp.14112 -
Current Allergy and Asthma Reports Mar 2016PPIs are among the most commonly administered medications in the USA and are generally well tolerated. Immediate and delayed immune-mediated hypersensitivity reactions... (Review)
Review
PPIs are among the most commonly administered medications in the USA and are generally well tolerated. Immediate and delayed immune-mediated hypersensitivity reactions are rare but increasingly recognized adverse effects of proton pump inhibitors (PPIs). Immediate hypersensitivity reactions can occur due to IgE-mediated hypersensitivity to PPIs and can be evaluated by immediate hypersensitivity skin testing and oral provocation challenge testing. A desensitization protocol can be used when PPI use cannot be avoided in an allergic patient. Delayed hypersensitivity reactions to PPIs have also been reported. Occupational exposures causing cutaneous reactions to PPIs are the most commonly reported delayed hypersensitivity reaction, followed by drug-induced subacute cutaneous lupus erythematosus. This review presents a summary of the clinical presentation, diagnostic evaluation, and management of immune-mediated hypersensitivity reactions to PPIs.
Topics: Animals; Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Lupus Erythematosus, Cutaneous; Proton Pump Inhibitors; Skin Tests
PubMed: 26810177
DOI: 10.1007/s11882-016-0595-8 -
Dermatitis : Contact, Atopic,... 2020: Wine, beer, liquor, and spirits are widely consumed in many cultures across the globe, and for some individuals, ingestion, cutaneous contact, or other exposure can... (Review)
Review
: Wine, beer, liquor, and spirits are widely consumed in many cultures across the globe, and for some individuals, ingestion, cutaneous contact, or other exposure can lead to dermatologic findings. However, there currently exist no comprehensive reviews on alcohol-related dermatitis. Herein, we will provide an overview of alcohol-related dermatitis and contact urticaria, including the epidemiology and clinical manifestations, potential allergens found in alcoholic beverages, testing approaches, and strategies for allergen avoidance.
Topics: Alcoholic Beverages; Balsams; Beer; Chromium; Citrus; Cobalt; Dermatitis; Dermatitis, Allergic Contact; Food Preservatives; Gold; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Isothiocyanates; Nickel; Propylene Glycol; Sulfites; Urticaria; Wine
PubMed: 32217881
DOI: 10.1097/DER.0000000000000579 -
Annual Review of Medicine 2015The immunological mechanisms driving delayed hypersensitivity reactions (HSRs) to drugs mediated by drug-reactive T lymphocytes are exemplified by several key examples... (Review)
Review
The immunological mechanisms driving delayed hypersensitivity reactions (HSRs) to drugs mediated by drug-reactive T lymphocytes are exemplified by several key examples and their human leukocyte antigen (HLA) associations: abacavir and HLA-B*57:01, carbamazepine and HLA-B*15:02, allo-purinol and HLA-B*58:01, and both amoxicillin-clavulanate and nevirapine with multiple class I and II alleles. For HLA-restricted drug HSRs, specific class I and/or II HLA alleles are necessary but not sufficient for tissue specificity and the clinical syndrome. Several models have been proposed to explain the immunopathogenesis of severe T cell-mediated drug HSRs, and our increased understanding of the risk factors and mechanisms involved in the development of these reactions will further the development of sensitive and specific strategies for preclinical screening that will lead to safer and more cost-effective drug design.
Topics: Drug Hypersensitivity; Drug Hypersensitivity Syndrome; HLA Antigens; Humans; Hypersensitivity, Delayed; Stevens-Johnson Syndrome; T-Lymphocytes
PubMed: 25386935
DOI: 10.1146/annurev-med-050913-022745 -
Annales de Dermatologie Et de... Mar 2018
Review
Topics: Antineoplastic Agents; Antirheumatic Agents; Diagnosis, Differential; Drug Eruptions; Drug Hypersensitivity Syndrome; Histamine Release; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Stevens-Johnson Syndrome
PubMed: 29428446
DOI: 10.1016/j.annder.2018.01.031 -
Immunology and Allergy Clinics of North... May 2022In evaluating adverse drug reactions (ADRs), patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) are useful tools for identifying responsible drugs... (Review)
Review
In evaluating adverse drug reactions (ADRs), patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) are useful tools for identifying responsible drugs and finding safe alternatives. Their diagnostic value depends on the clinical features of the ADR and on the drug tested. PTs have a good sensitivity in assessing acute generalized exanthematous pustulosis and drug rash with eosinophilia and systemic symptoms. SPTs done with all drugs except opiates are used for immediate hypersensitivity reactions. IDTs seem sensitive for immediate hypersensitivity reactions to beta-lactam antibiotics, iodinated contrast media, heparins, general anesthetics, and platinum salts.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Patch Tests; Skin Tests
PubMed: 35469620
DOI: 10.1016/j.iac.2022.01.003