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Delayed hypersensitivity reactions to iodinated contrast media: A diagnostic approach by skin tests.Contact Dermatitis Nov 2023Adverse drug reactions to iodinated contrast media (ICM) have risen due to their increasing use in x-ray-based imaging modalities. Delayed hypersensitivity reactions are...
BACKGROUND
Adverse drug reactions to iodinated contrast media (ICM) have risen due to their increasing use in x-ray-based imaging modalities. Delayed hypersensitivity reactions are mainly caused by nonionic monomeric compounds and represent an issue impacting the diagnostic-therapeutic pathways of cancer, cardiology and surgery patients.
OBJECTIVES
To prospectively evaluate the usefulness of skin tests in delayed hypersensitivity reactions to ICM and to evaluate the tolerability of iobitridol, a monomeric nonionic low osmolality compound, as a possible safe alternative.
METHODS
Patients with delayed hypersensitivity reactions to ICM referred to us from 2020 to 2022 were prospectively enrolled in the study. All patients underwent patch test and, if negative, intradermal test with the culprit ICM and iobitridol as alternative.
RESULTS
A total of 37 patients (females 24, 64.9%) were enrolled in the study. Iodixanol and iomeprol were the most frequently involved ICM (48.5% and 35.2%, respectively); 62.2% of patients presented maculopapular eruption, while 37.8% reported delayed urticaria-like rash. Skin tests resulted positive to the culprit ICM in 19 patients (51.4%), 16 to patch test and 3 to intradermal test. Skin tests with iobitridol, tested as alternative, resulted positive in 3/19 patients (15.8%). All 16 patients with negative results to iobitridol were administered this ICM and tolerated it.
CONCLUSIONS
In at least half of patients, delayed-type hypersensitivity was demonstrated by skin tests, particularly by patch test. This diagnostic approach resulted simple, cost-effective and safe, not only to confirm the culprit ICM but also to identify iobitridol as feasible alternative.
Topics: Female; Humans; Contrast Media; Drug Hypersensitivity; Dermatitis, Allergic Contact; Skin Tests; Iodine Compounds; Exanthema; Hypersensitivity, Delayed
PubMed: 37394777
DOI: 10.1111/cod.14372 -
American Journal of Physiology. Lung... Apr 2024
Topics: Humans; Fund Raising; Sarcoidosis
PubMed: 38471073
DOI: 10.1152/ajplung.00084.2024 -
La Tunisie Medicale Oct 2023Sarcoidosis is a systemic granulomatosis that can be associated with large-scale physical and mental disability, affecting the health related quality-of-life (HRQoL) of...
INTRODUCTION
Sarcoidosis is a systemic granulomatosis that can be associated with large-scale physical and mental disability, affecting the health related quality-of-life (HRQoL) of patients.
AIM
To evaluate the HRQoL of tunisian patients with sarcoidosis and to identify the factors that influence it.
METHODS
We conducted an analytical, cross-sectional study collecting 31 patients with sarcoidosis according to the ATS/ERS/WASOG criteria. The evaluation of the HRQoL was assessed by two questionnaires in tunisian dialect. The generic score was the Medical Outcome Study 36-Short Form Health Survey (SF-36).The specific score used was the Sarcoidosis Health Questionnaire (SHQ).
RESULTS
The HRQoL of our 31 patients was more affected in the three domains of the SHQ compared to the SF-36, which is in favor of the better sensitivity of the SHQ to detect the influence of the extent of sarcoidosis on the HRQoL. Factors associated with more impaired HRQoLwere: age at disease onset, age at interview, comorbidities, altered spirometry results, ocular involvement, chronic cholestasis, splenic nodules, arthralgia, organ count ≥3, lymphopenia and cholestasis at the time of the interview. Taking an immunosuppressant agent, particularly Methotrexate, was associated with HRQoL improvement. The number of relapses was the most correlated factor with an altered HRQoL, and this in several domains.
CONCLUSION
For an effective management of patients with sarcoidosis, a bio-psycho-social approach is now necessary in order to assess the real and global impact of the disease and to improve the HRQoL of patients. Disease-specific scores seem more reliable in achieving these goals.
Topics: Humans; Cross-Sectional Studies; Tunisia; Quality of Life; Sarcoidosis; Surveys and Questionnaires; Cholestasis
PubMed: 38465758
DOI: No ID Found -
JACC. Cardiovascular Imaging Jan 2024
Topics: Humans; Predictive Value of Tests; Sarcoidosis; Cardiomyopathies; Myocarditis
PubMed: 38176848
DOI: 10.1016/j.jcmg.2023.12.001 -
Therapie 2024Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality....
Cutaneous adverse drug reactions (ADRs) represent a heterogeneous field including various clinical patterns without specific features suggesting drug causality. Maculopapular exanthema and urticaria are the most common types of cutaneous ADR. Serious cutaneous ADRs, which may cause permanent sequelae or have fatal outcome, may represent 2% of all cutaneous ADR and must be quickly identified to guide their management. These serious reactions include bullous manifestations (epidermal necrolysis i.e. Stevens-Johnson syndrome and toxic epidermal necrolysis), drug reaction with eosinophilia and systemic symptoms (DRESS) and acute generalized exanthematous pustulosis (AGEP). Some risk factors for developing cutaneous ADRs have been identified, including immunosuppression, autoimmunity or genetic variants. All drugs can cause cutaneous ADRs, the most commonly implicated being antibiotics (especially aminopenicillins and sulfonamides), anticonvulsants, allopurinol, antineoplastic drugs, non-steroidal anti-inflammatory drugs and iodinated contrast media. Pathophysiology is related to immediate or delayed "idiosyncratic" immunologic mechanisms, i.e., usually not related to dose, and pharmacologic/toxic mechanisms, commonly dose-dependent and/or time-dependent. If an immuno-allergic mechanism is suspected, allergological explorations (including epicutaneous patch testing and/or intradermal test) are often possible to clarify drug causality, however these have a variable sensitivity according to the drug and to the ADR type. No in vivo or in vitro test can consistently confirm the drug causality. To determine the origin of a rash, a logical approach based on clinical characteristics, chronologic factors and elimination of differential diagnosis (especially infectious etiologies) is required, completed with a literature search. Reporting to pharmacovigilance system is therefore essential both to analyze drug causality at individual level, and to contribute to knowledge of the drug at population level, especially for serious cutaneous ADRs or in cases involving newly marketed drugs.
Topics: Humans; Skin; Stevens-Johnson Syndrome; Anti-Bacterial Agents; Acute Generalized Exanthematous Pustulosis; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 37980248
DOI: 10.1016/j.therap.2023.09.011 -
Lung Oct 2023Sarcoidosis is a complex disease which can affect nearly every organ system with manifestations ranging from asymptomatic imaging findings to sudden cardiac death. As... (Review)
Review
PURPOSE
Sarcoidosis is a complex disease which can affect nearly every organ system with manifestations ranging from asymptomatic imaging findings to sudden cardiac death. As such, diagnosis and prognostication are topics of continued investigation. Recent technological advancements have introduced multiple modalities of artificial intelligence (AI) to the study of sarcoidosis. Machine learning, deep learning, and radiomics have predominantly been used to study sarcoidosis.
METHODS
Articles were collected by searching online databases using keywords such as sarcoid, machine learning, artificial intelligence, radiomics, and deep learning. Article titles and abstracts were reviewed for relevance by a single reviewer. Articles written in languages other than English were excluded.
CONCLUSIONS
Machine learning may be used to help diagnose pulmonary sarcoidosis and prognosticate in cardiac sarcoidosis. Deep learning is most comprehensively studied for diagnosis of pulmonary sarcoidosis and has less frequently been applied to prognostication in cardiac sarcoidosis. Radiomics has primarily been used to differentiate sarcoidosis from malignancy. To date, the use of AI in sarcoidosis is limited by the rarity of this disease, leading to small, suboptimal training sets. Nevertheless, there are applications of AI that have been used to study other systemic diseases, which may be adapted for use in sarcoidosis. These applications include discovery of new disease phenotypes, discovery of biomarkers of disease onset and activity, and treatment optimization.
Topics: Humans; Artificial Intelligence; Sarcoidosis, Pulmonary; Sarcoidosis; Machine Learning; Databases, Factual
PubMed: 37730926
DOI: 10.1007/s00408-023-00641-7 -
Asian Pacific Journal of Allergy and... Dec 2023Drug reaction with eosinophilia and systemic symptoms (DRESS) and drug-induced liver injury (DILI) can hamper therapeutic strategy, contribute to multiple drug... (Review)
Review
Drug reaction with eosinophilia and systemic symptoms (DRESS) and drug-induced liver injury (DILI) can hamper therapeutic strategy, contribute to multiple drug resistance and serious public health burden. Diagnosis (including allergy assessment) and management of these two severe hypersensitivity reactions in clinical practice are somewhat difficult and published scientific evidence is rather weak and limited. The first step is always represented by stopping all anti-tuberculosis (TB) drugs, treating reaction with systemic corticosteroids, and identifying the offending drug, even if it is often complicated by the patient's simultaneous intake of antibiotics. Patch tests and in vitro tests, such as lymphocyte transformation test, could bridge this diagnostic gap, but the available data are scarce and their sensitivity low. The re-challenge test is often necessary but places patients at risk for serious adverse reactions. The desensitization protocols are quite varied and not universally accepted. In this narrative review, we provide an update to the literature data on the management of DRESS and DILI with particular attention to the allergological work-up in the last decade.
Topics: Humans; Antitubercular Agents; Drug Hypersensitivity Syndrome; Eosinophilia; Hypersensitivity
PubMed: 37874314
DOI: 10.12932/AP-010423-1582 -
Heart Failure Clinics Oct 2023A high clinical suspicion in the setting of appropriate history, physical exam, laboratory, and imaging parameters is often required to set the groundwork for diagnosis... (Review)
Review
A high clinical suspicion in the setting of appropriate history, physical exam, laboratory, and imaging parameters is often required to set the groundwork for diagnosis and management. Echocardiography may show septal thinning, evidence of systolic and diastolic dysfunction, along with impaired global longitudinal strain. Cardiac MRI reveals late gadolinium enhancement along with evidence of myocardial edema and inflammation on T2 weighted imaging and parametric mapping. 18F-FDG PET detects the presence of active inflammation and the presence of scar. Involvement of the right ventricle on MRI or PET confers a high risk for adverse cardiac events and mortality.
Topics: Humans; Contrast Media; Gadolinium; Sarcoidosis; Inflammation; Echocardiography
PubMed: 37714588
DOI: 10.1016/j.hfc.2023.06.002 -
Cutis Sep 2023Historically, US servicemembers have faced unique environmental hazards that may increase their risk for developing sarcoidosis. Cutaneous sarcoidosis is the most common... (Review)
Review
Historically, US servicemembers have faced unique environmental hazards that may increase their risk for developing sarcoidosis. Cutaneous sarcoidosis is the most common extrapulmonary manifestation of sarcoidosis and can precede systemic manifestations of the disease. In this article, we review the literature to examine the risk factors and incidence of sarcoidosis in post-9/11 veterans as well as provide recommendations for workup and management. Importantly, we also highlight that sarcoidosis is a presumptive diagnosis under the recently enacted Promise to Address Comprehensive Toxics (PACT) Act and may be service connected. Veterans with sarcoidosis should be referred to the US Department of Veterans Affairs.
Topics: Humans; Veterans; Sarcoidosis; Risk Factors; Incidence; Military Personnel
PubMed: 37903400
DOI: 10.12788/cutis.0852 -
Current Opinion in Pulmonary Medicine Sep 2023The current review aims to highlight the role of primary care physicians in the diagnosis, treatment and monitoring of patients with sarcoidosis. Increased awareness of... (Review)
Review
PURPOSE OF REVIEW
The current review aims to highlight the role of primary care physicians in the diagnosis, treatment and monitoring of patients with sarcoidosis. Increased awareness of the clinical and imaging manifestations of the disease as well as the natural disease course will help for earlier and more accurate diagnosis as well as detection of high-risk patients who would benefit from treatment introduction.
RECENT FINDINGS
Recent guidelines have attempted to deal with the confusion related to treatment indications, duration and monitoring of treatment in patients with sarcoidosis. Nonetheless, important points require further clarification. Primary care physicians may be the first to confront disease exacerbation, deterioration despite treatment and/or treatment-induced side effects. Furthermore, they are the physicians that remain closer to the patient providing a significant amount of information, psychological support and assessment for sarcoidosis-specific or not issues. The treatment strategy for each organ is complex, but the principles of treatment have been explored.
SUMMARY
There have been considerable advances in the diagnostic and management approach of patients with sarcoidosis. Multidisciplinary approach for both diagnosis and management seems optimal. Validating risk stratification strategies and standardizing the monitoring process is appropriate for the future.
Topics: Humans; Sarcoidosis; Disease Progression; Primary Health Care
PubMed: 37410457
DOI: 10.1097/MCP.0000000000000991