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Immunology and Allergy Clinics of North... Aug 2014Antiviral drugs used to treat HIV and hepatitis C are common causes of delayed drug hypersensitivities for which many of the more severe reactions have been recently... (Review)
Review
Antiviral drugs used to treat HIV and hepatitis C are common causes of delayed drug hypersensitivities for which many of the more severe reactions have been recently shown to be immunogenetically mediated such as abacavir hypersensitivity where HLA-B(∗)57:01 is now used routinely as a screening test to exclude patients carrying this allele from abacavir prescription. Most antiviral drug allergies consist of mild to moderate delayed rash without other serious features (eg, fever, mucosal involvement, blistering rash, organ impairment. In these cases treatment can be continued with careful observation and symptomatic management and the discontinuation rate is low.
Topics: Antiviral Agents; Disease Management; Drug Hypersensitivity; Humans
PubMed: 25017682
DOI: 10.1016/j.iac.2014.04.011 -
The Journal of Allergy and Clinical... May 2024When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that...
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
Topics: Humans; Diagnosis, Differential; Female; Male; Drug Hypersensitivity; Middle Aged; Lymphohistiocytosis, Hemophagocytic; Adult; Aged; Diagnostic Errors; Drug Hypersensitivity Syndrome
PubMed: 38325764
DOI: 10.1016/j.jaip.2024.01.047 -
Pediatrics May 2018The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can... (Review)
Review
The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug-virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.
Topics: Anti-Bacterial Agents; Antimicrobial Stewardship; Child; Cost of Illness; Cross Reactions; Drug Hypersensitivity; Humans; Medical Overuse; Penicillins
PubMed: 29700201
DOI: 10.1542/peds.2017-2497 -
Current Opinion in Allergy and Clinical... Aug 2020As drug allergy research aims to inform clinical practice, implementation of best practices may be influenced by financial resources required to incorporate new... (Review)
Review
PURPOSE OF REVIEW
As drug allergy research aims to inform clinical practice, implementation of best practices may be influenced by financial resources required to incorporate new interventions and the resulting clinical and economic returns on those resource investments. The present review summarizes new insights into the economics of drug allergy over the past year.
RECENT FINDINGS
While considering economic implications of recent drug allergy research, many studies have addressed different contextual factors related to the setting, provider, or outcomes. Advances in technology have enabled specialized allergists to support remote settings through telemedicine consultation. Training opportunities and interdisciplinary approaches to address drug allergy challenges have enabled multiple provider types to play a role in screening, diagnosis, and management. Penicillin allergy testing has been a major focus for many institutions, with several studies focused on de-labeling strategies including confirmatory skin testing and direct oral challenges.
SUMMARY
Studies over the past year provide new opportunities for the field of drug allergy research. The focus of current research to capture direct health costs or savings associated with drug allergy interventions demonstrates opportunity for more cost-effective care delivery and opportunity to explore greater benefits to society.
Topics: Allergists; Anti-Bacterial Agents; Cost Savings; Cost of Illness; Cost-Benefit Analysis; Drug Hypersensitivity; Health Care Costs; Health Plan Implementation; Humans; Penicillins; Practice Patterns, Physicians'; Skin Tests
PubMed: 32452890
DOI: 10.1097/ACI.0000000000000651 -
Clinical Reviews in Allergy & Immunology Feb 2019Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to... (Review)
Review
Systemic contact dermatitis (SCD) traditionally refers to a skin condition where an individual who is cutaneously sensitized to an allergen will subsequently react to that same allergen or a cross reacting allergen via a different route. It occurs to allergens including metals, medications, and foods. The exact pathophysiology underlying this disease remains unknown, although it appears to be mediated by type 4 hypersensitivity reactions and possibly type 3 hypersensitivity reactions. The p-I concept (pharmacologic interaction with immunoreceptors) hypothesized that drugs are able to bind directly to a T cell receptor without first being presented by MHC (major histocompatibility complex) molecules and without prior metabolism, which would help explain why SCD can be seen on first exposure to medications. Nomenclature remains a challenge as SCD can be subcategorized using terms such as ACDS (allergic contact dermatitis syndrome) and its four clinical stages, Baboon syndrome, and SDRIFE (symmetrical drug-related intertriginous and flexural exanthema), which share many overlapping features. Food allergens may be responsible for uncontrolled or persistent symptoms in patients with contact dermatitis who do not respond to topical avoidance. With medications, symptoms may be induced by topical application versus systemic administration. Patch testing (PT) may be beneficial in diagnosing SCD caused by metals and many topical medications including corticosteroids, antimicrobials (ampicillin, bacitracin, erythromycin, neomycin, nystatin), NSAIDs (diclofenac, ibuprofen), anesthetics, and antihistamines (chlorphenamine, piperazine). Current treatment options include topical steroids and oral antihistamines for symptom relief and dietary avoidance to causative foods or metals.
Topics: Allergens; Animals; Dermatitis, Contact; Drug Hypersensitivity; Food Hypersensitivity; Humans
PubMed: 29766368
DOI: 10.1007/s12016-018-8686-z -
Annals of Allergy, Asthma & Immunology... Feb 2023
Topics: Humans; Drug Hypersensitivity; Biomarkers
PubMed: 36737154
DOI: 10.1016/j.anai.2022.10.017 -
Allergy Apr 2021
Topics: Drug Hypersensitivity; Humans; Hypersensitivity; Hypersensitivity, Immediate; Skin Tests
PubMed: 32780432
DOI: 10.1111/all.14555 -
Handbook of Experimental Pharmacology 2022Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type...
Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type reactions reveal a high variability. In both cases it may not always be easy to differentiate drug reactions from non-drug-induced skin conditions. Furthermore, the different types of cutaneous adverse reactions may be difficult to distinguish in the beginning. This accounts predominately for delayed hypersensitivity reactions that can occur after a variety of medications and present with manifold lesions. Most of these cutaneous adverse reactions are mild, but some are severe with high morbidity and mortality. In the clinical setting, it is important to recognize the signs that point to a more severe condition early on in order to initiate appropriate management. In addition, it is crucial to identify the potentially culprit medication on the basis of a detailed medication history and by evaluating the relevant exposure times of certain drugs that differ substantially between the various reaction types. After the acute stage of the adverse reaction is managed successfully, further allergologic testing may be undertaken to confirm the offending drug.
Topics: Drug Hypersensitivity; Humans; Skin; Skin Tests
PubMed: 34219202
DOI: 10.1007/164_2021_490 -
Current Opinion in Allergy and Clinical... Aug 2021Drug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug... (Review)
Review
PURPOSE OF REVIEW
Drug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug allergy testing and considerations in the management. Especially in the era of COVID-19, the elderly population is a vulnerable cohort and reviewing the management during this unprecedented time is both timely and relevant.
RECENT FINDINGS
In recent years, larger scale studies focusing on the epidemiology and prevalence trends of drug allergies among older adults has been summarized in this review. Emphasis on anaphylaxis in the older adults has been studied.
SUMMARY
There are many implications of these findings. Epidemiological studies are useful in realizing the burden and spectrum of drug allergies on our healthcare system. It has allowed us to identify certain barriers in drug allergy management and develop ways to overcome these challenges through. Lastly, we have proposed an approach to drug allergy management based on previous studies as well as from our perspective and local experience.
Topics: Age Factors; Aged; Aging; COVID-19; Desensitization, Immunologic; Drug Hypersensitivity; Drug Labeling; Global Burden of Disease; Humans; Prevalence; Risk Factors; SARS-CoV-2; COVID-19 Drug Treatment
PubMed: 34101633
DOI: 10.1097/ACI.0000000000000761 -
CMAJ : Canadian Medical Association... Apr 2018
Review
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Clinical Laboratory Techniques; Drug Eruptions; Drug Hypersensitivity; Humans; Medical History Taking; Skin Tests
PubMed: 29712672
DOI: 10.1503/cmaj.171315