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Allergy Apr 2021
Topics: Drug Hypersensitivity; Humans; Hypersensitivity; Hypersensitivity, Immediate; Skin Tests
PubMed: 32780432
DOI: 10.1111/all.14555 -
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 -
Allergology International : Official... Apr 2022Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory... (Review)
Review
Non-HIV immune reconstitution inflammatory syndrome (non-HIV IRIS) is associated with the recovery from an immunocompromised condition. It is defined as inflammatory disorders caused by antigens, including drugs or pathogenic microorganisms present prior to immune recovery, or by the exacerbation of an inflammatory disorder that was already present. Drug-induced hypersensitivity syndrome is a prototype of IRIS, and the pathophysiology of non-HIV IRIS can be recognized in several disorders treated with corticosteroids, immunosuppressants, molecular-targeted drugs, TNF-α antibody drugs, immune checkpoint inhibitors, and dipeptidyl peptidase-4 inhibitors. This review focuses on the relationship between the immune mechanism of non-HIV IRIS and drug allergies, especially severe drug eruption. The antigen recognition mechanism in drug allergy varies depending on the clinical type and the causative drug. The p-i concept is the main mechanism in severe drug eruption such as Stevens-Johnson syndrome/toxic epidermal necrolysis, and drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms. Lymphocytes activated by an antigen other than a drug, such as a virus, can also develop drug allergy by the loose binding of drugs with immune receptors of T cells or human leukocyte antigen. Therefore, fluctuations in the immune environment affect the onset of severe drug eruption. Novel agents that cause major changes in immunity have been marketed mainly for autoimmune diseases and malignant tumors; therefore, it is necessary to consider their effects when treating severe drug eruptions. Moreover, although a list of diagnostic criteria for this syndrome has been drafted, predictive and diagnostic biomarkers for this syndrome needs to be urgently developed.
Topics: Adrenal Cortex Hormones; Drug Hypersensitivity Syndrome; Eosinophilia; Humans; Immune Reconstitution Inflammatory Syndrome; Stevens-Johnson Syndrome
PubMed: 35236619
DOI: 10.1016/j.alit.2021.12.002 -
The Journal of Allergy and Clinical... Jan 2019Drug allergy pathways are standardized approaches for patients reporting prior drug allergies with the aim of quality improvement and promotion of antibiotic... (Review)
Review
Drug allergy pathways are standardized approaches for patients reporting prior drug allergies with the aim of quality improvement and promotion of antibiotic stewardship. At the International Drug Allergy Symposium during the 2018 American Academy of Allergy, Asthma, and Immunology/World Allergy Organization Joint Congress in Orlando, Florida, drug allergy pathways were discussed from international perspectives with a focus on beta-lactam allergy pathways and pragmatic approaches for acute care hospitals. In this expert consensus document, we review current pathways, and detail important considerations in devising, implementing, and evaluating beta-lactam allergy pathways for hospitalized patients. We describe the key patient and institutional factors that must be considered in risk stratification, the central feature of pathway design. We detail shared obstacles to widespread beta-lactam allergy pathway implementation and identify potential solutions to address these challenges.
Topics: Allergens; Anti-Bacterial Agents; Congresses as Topic; Consensus; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Expert Testimony; Humans; International Cooperation; Policy; Practice Guidelines as Topic; Quality Improvement; Risk Adjustment; United States; beta-Lactams
PubMed: 30573422
DOI: 10.1016/j.jaip.2018.07.037 -
Immunology and Allergy Clinics of North... May 2022The imagery of pigmented skin is underrepresented in teaching materials such as textbooks, journals, and online references, and this has resulted in poorer diagnostic... (Review)
Review
The imagery of pigmented skin is underrepresented in teaching materials such as textbooks, journals, and online references, and this has resulted in poorer diagnostic and management outcomes of skin pathology, including delayed cutaneous drug hypersensitivity reactions. In this review, we use clinical images to highlight factors that impact clinical presentations and sequelae of drug hypersensitivity reactions in pigmented skin compared with nonpigmented skin. We describe clinical features in some anatomic sites that aid diagnosis or are associated with more severe sequelae. Finally, we discuss strategies that may aid the diagnosis and management of these reactions in pigmented skin.
Topics: Drug Hypersensitivity; Humans; Skin
PubMed: 35469616
DOI: 10.1016/j.iac.2022.01.005 -
Pediatric Allergy and Immunology :... Dec 2019The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: "Allergy," "Pediatric Allergy and Immunology (PAI)," and "Clinical and... (Review)
Review
The European Academy of Allergy and Clinical Immunology (EAACI) supports three journals: "Allergy," "Pediatric Allergy and Immunology (PAI)," and "Clinical and Translational Allergy (CTA)." One of the major goals of EAACI is to support health promotion in which prevention of allergy and asthma plays a critical role and to disseminate the knowledge of allergy to all stakeholders including the EAACI junior members. This paper summarizes the achievements of 2018 in anaphylaxis, and food and drug allergy. Main topics that have been focused are anaphylaxis, mechanisms of food allergy (FA), epidemiology of FA, food allergens, diagnosis of FA, prevention and control of FA, FA immunotherapy, drug allergy, and political agenda.
Topics: Allergy and Immunology; Anaphylaxis; Animals; Desensitization, Immunologic; Drug Hypersensitivity; Europe; Food Hypersensitivity; Humans; Information Dissemination; Societies, Scientific
PubMed: 31539176
DOI: 10.1111/pai.13125 -
Clinical Reviews in Allergy & Immunology Jun 2022Drug allergy delabeling programs have become an essential element of antibiotic stewardship. Development of delabeling programs involves careful selection of target... (Review)
Review
Drug allergy delabeling programs have become an essential element of antibiotic stewardship. Development of delabeling programs involves careful selection of target patient population, thoughtful design of delabeling approach, stakeholder engagement, assembly of key team members, implementation, and evaluation of clinical and safety outcomes. Recent programs have targeted patients thought to be most likely to benefit from removal of inaccurate antibiotic allergy labels, those with β-lactam antibiotic allergies and high-risk populations likely to need β-lactam antibiotics as first-line treatment. This review provides an overview of current risk stratification methods and β-lactam cross-reactivity data and summarizes how different inpatient and outpatient delabeling programs have used these concepts in delabeling algorithms. β-Lactam delabeling programs for inpatients, pediatric patients, and programs utilizing telehealth have been implemented with good outcomes. This review also focuses on delabeling programs for high-risk populations likely to benefit from first-line β-lactam antibiotics. These populations include perioperative, prenatal, and immunocompromised patients. Delabeling programs have been successful in the inpatient and outpatient settings at enabling appropriate antibiotic use. This article reviews delabeling strategies utilized by these programs with a focus on highlighting elements key to their success and future areas for innovation.
Topics: Anti-Bacterial Agents; Child; Cross Reactions; Drug Hypersensitivity; Humans; Penicillins; Telemedicine; beta-Lactams
PubMed: 35031956
DOI: 10.1007/s12016-021-08913-x -
Annals of Allergy, Asthma & Immunology... Feb 2019This article reviews the latest science and epidemiologic studies related to drug allergy in children and adults to explore possible mechanisms related to female... (Review)
Review
OBJECTIVE
This article reviews the latest science and epidemiologic studies related to drug allergy in children and adults to explore possible mechanisms related to female propensity for drug allergy.
DATA SOURCES
PubMed literature review, focusing primarily on the last 5 years.
STUDY SELECTIONS
Articles reviewing the science behind female predisposition to atopic and asthmatic conditions and epidemiologic studies reviewing drug allergy and drug-induced anaphylaxis.
RESULTS
Despite adult female predilection for atopic conditions, few laboratory studies explore sex-specific mechanisms in atopic/allergic diseases, and most are focused on autoimmunity and asthma. Drug allergy is more frequently reported in adult females compared with adult males. Adult females are also more likely to have drug-induced anaphylaxis (DIA), although no clear sex predominance has been reported in fatal or severe DIA. Studies in children suggest the reverse picture, with prepubertal males more likely to have drug allergy and DIA than prepubertal girls.
CONCLUSION
Possible explanations for female predisposition for drug allergy are multifactorial and include disproportionate utilization of health care with more exposure to antibiotics or medications, genetic factors related to the X chromosome, epigenetic changes, and discrepant hormonal interactions with immune cells.
Topics: Adaptive Immunity; Adult; Anaphylaxis; Anti-Inflammatory Agents, Non-Steroidal; Child; Chromosomes, Human, X; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Female; Gonadal Steroid Hormones; Humans; Immunity, Innate; Male; Sex Characteristics
PubMed: 30465863
DOI: 10.1016/j.anai.2018.11.014 -
Immunology and Allergy Clinics of North... Feb 2017Drug hypersensitivity reactions may manifest with either organ-specific or systemic symptoms, but cutaneous eruptions are the most common manifestations. Different... (Review)
Review
Drug hypersensitivity reactions may manifest with either organ-specific or systemic symptoms, but cutaneous eruptions are the most common manifestations. Different medications may cause identical skin symptoms, whereas hypersensitivity to a single drug may manifest with various patterns of symptoms depending on the pathomechanism of hypersensitivity. Drug reactions should be also taken into account in the differential diagnosis of numerous skin rashes. Analysis of morphology of drug-induced lesions, about potential immunologic or nonimmunological mechanisms, is important for the final diagnosis. Thus, here the authors present a morphologic approach to the diagnosis of cutaneous drug-induced eruptions.
Topics: Anaphylaxis; Angioedema; Diagnosis, Differential; Drug Eruptions; Humans; Hypersensitivity, Delayed; Skin; Urticaria
PubMed: 27886905
DOI: 10.1016/j.iac.2016.08.006 -
Pediatric Allergy and Immunology :... May 2023
Topics: Humans; Child; Drug Hypersensitivity; Anti-Bacterial Agents
PubMed: 37232287
DOI: 10.1111/pai.13957