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International Journal of Molecular... Jul 2023In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant... (Review)
Review
In recent years, there has been a noticeable development in oncological treatment, including chemotherapy and biological treatment. Despite their significant effectiveness, they are not free from side effects, such as allergic and dermatological reactions. These reactions can vary in severity and outcome, including potential death. Examples, among others, are type I-IV hypersensitivity reactions of various origins and skin reactions including rashes, itching and redness, but also severe cutaneous syndromes. Due to the therapy used, these may include Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, drug-induced hypersensitivity syndrome and acute generalized exanthematous pustulosis. In some cases, it is necessary to interrupt therapy, which may result in a poorer outcome and shorten the patient's survival. This paper reviews various types of research documents published since 2016. It aims to systematize the latest knowledge and highlight the need for further research into ways to avoid adverse reactions.
Topics: Humans; Skin; Stevens-Johnson Syndrome; Acute Generalized Exanthematous Pustulosis; Drug Hypersensitivity Syndrome; Eosinophilia
PubMed: 37511017
DOI: 10.3390/ijms241411257 -
The Journal of Allergy and Clinical... Mar 2024Systemic immunotherapeutics have been a clinical staple in the treatment of cancer, infectious diseases, organ and cell transplantation, autoimmunity, and allergies.... (Review)
Review
Systemic immunotherapeutics have been a clinical staple in the treatment of cancer, infectious diseases, organ and cell transplantation, autoimmunity, and allergies. Although their utility remains unquestioned, systemic administration of these drugs is associated with limited efficacy, significant adverse off-target effects, transient activity, and the requirement for frequent repeated dosing. To this end, recent technological advancements have provided novel means for sustained drug delivery to specific tissues and targeted localized approaches for immunotherapeutics. In this article, we present various cutting-edge platform technologies, including implants, multireservoir systems, and scaffolds encapsulating immunomodulatory agents for local administration. Examples of their application in cancer, cell transplantation, allergy, and infectious diseases are discussed, highlighting the potential of such systems for innovative immunomodulatory intervention.
Topics: Humans; Immunomodulation; Drug Delivery Systems; Neoplasms; Administration, Cutaneous; Communicable Diseases
PubMed: 38253261
DOI: 10.1016/j.jaci.2024.01.004 -
Frontiers in Pharmacology 2023Beta-lactam antibiotics are one of the most common causes of antibiotics-related severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS),...
Beta-lactam antibiotics are one of the most common causes of antibiotics-related severe cutaneous adverse reactions (SCARs) including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug reactions with eosinophilia and systemic symptoms (DRESS), and acute generalized exanthematous pustulosis (AGEP). Recent evidence demonstrated that the human leukocyte antigen () polymorphisms play important roles in the development of drug-related SCARs. This study aimed to extensively characterize the associations between genetic polymorphisms and several phenotypes of SCARs related to beta-lactam antibiotics. Thirty-one Thai patients with beta-lactam antibiotics-related SCARs were enrolled in the study. A total of 183 unrelated native Thai subjects without any evidence of drug allergy were recruited as the control group. Genotyping of class I and class II alleles was performed. Six alleles including , , , , , and , were significantly associated with beta-lactam antibiotics-related SCARs. The highest risk of SCARs was observed in patients with the allele (OR = 12.6, 95% CI = 1.1-142.9, = 0.042), followed by the allele (OR = 5.8, 95% CI = 1.5-22.0, = 0.012) and the allele (OR = 5.7, 95% CI = 1.6-19.9, = 0.011). According to the phenotypes of SCARs related to beta-lactam antibiotics, the higher risk of SJS/TEN was observed in patients with , (OR = 17.5, 95% CI = 1.5-201.6, = 0.033), , (OR = 9.5, 95% CI = 1.3-71.5, = 0.028), (OR = 7.5, 95% CI = 1.8-30.9, = 0.008), or (OR = 4.9, 95% CI = 1.1-21.4, = 0.008). While eight alleles including , , , , , , , and were associated with AGEP, the highest risk of AGEP was observed in patients with the allele (OR = 60.7, 95% CI = 4.8-765.00, = 0.005). Among the four alleles associated with DRESS including , , , and , the allele had the highest risk of beta-lactam antibiotics-related DRESS (OR = 60.0, 95% CI = 3.0-1202.1, = 0.043). However, these associations did not achieve statistical significance after Bonferroni's correction. Apart from the risk alleles, the allele appeared to be a protective factor against beta-lactam antibiotic-related SCARs (OR = 0.1, 95% CI = 0.0-0.5, = 3.7 × 10, Pc = 0.012). This study demonstrated the candidate alleles that are significantly associated with several phenotypes of beta-lactam antibiotics-related SCARs. However, whether the alleles observed in this study can be used as valid genetic markers for SCARs related to beta-lactam antibiotics needs to be further explored in other ethnicities and larger cohort studies.
PubMed: 37795024
DOI: 10.3389/fphar.2023.1248386 -
Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome in childhood: a narrative review.Frontiers in Medicine 2023Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and... (Review)
Review
Despite being rare, the Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a serious, possibly fatal condition that may affect both adults and children who may be also burdened by delayed sequelae. It is an adverse drug reaction characterized by widespread skin involvement, fever, lymphadenopathy, visceral involvement, and laboratory abnormalities (eosinophilia, mononucleosis-like atypical lymphocytes). It is more frequently triggered by anticonvulsants, sulphonamides, or antibiotics, the latter being responsible for up to 30% of pediatric cases. The disease typically develops 2-8 weeks after exposure to the culprit medication, with fever and widespread skin eruption; mild viral prodromes are possible. Unfortunately, diagnosis is challenging due to the absence of a reliable test; however, a score by the European Registry of Severe Cutaneous Adverse Reactions (RegiSCAR) allows to classify suspect patients into no, possible, probable, or definite DRESS cases. Moreover, rapid-onset DRESS syndrome has been described in recent years. It affects children more often than adults and differs from the most common form because it appears ≤15 days vs. >15 days after starting the drug, it is usually triggered by antibiotics or iodinated contrast media rather than by anticonvulsants and has a higher presence of lymphadenopathy. Differential diagnosis between rapid-onset antibiotic-driven DRESS syndrome, viral exanthems, or other drug eruptions may be challenging, but it is mandatory to define it as early as possible to start adequate treatment and monitor possible complications. The present review reports the latest evidence about the diagnosis and treatment of pediatric DRESS syndrome.
PubMed: 37575981
DOI: 10.3389/fmed.2023.1108345 -
International Journal of Occupational... Nov 2023On average about 10% of parents report hypersensitivity to at least 1 drug in their children. After diagnosis process a few of these reactions are being confirmed as...
OBJECTIVES
On average about 10% of parents report hypersensitivity to at least 1 drug in their children. After diagnosis process a few of these reactions are being confirmed as drug hypersensitivity reactions. The aim of the study was to assess the real-life prevalence of drug hypersensitivity in children based on drug provocation tests.
MATERIAL AND METHODS
The authors included 113 children, aged 4-18 years, referred to Pediatrics and Allergy Clinic in Łódź, Poland, due to incidence of adverse reaction during treatment. Medical history regarding allergies to drugs was taken in accordance to the form developed by the United States Food and Drug Administration Adverse Event Reporting System. Skin prick tests, intradermal test and drug provocation test were performed in all patients.
RESULTS
In all 113 patients suspected of drug allergy, after all diagnostic procedures, the authors proved IgE-mediated allergy to β-lactams, nonsteroid anti-inflammatory drugs, local anesthetics in 19 patients (16.8%). Previous history of allergy was a risk factor for drug allergy in studied patients (p = 0.001). The most frequent symptoms of allergy were urticaria and erythematous papular rash.
CONCLUSIONS
Drug allergy is a difficult problem in the practice of a doctor and is difficult to diagnose, especially in the pediatric population. It seems that too often isolated symptoms reported during infection or disease are taken as a symptom of drug allergy, and not as a symptom resulting from the course of the disease. Int J Occup Med Environ Health. 2023;36(5):632-42.
Topics: Child; Humans; Drug Hypersensitivity; Hypersensitivity; Skin Tests; beta-Lactams; Risk Factors; Anti-Bacterial Agents
PubMed: 37750429
DOI: 10.13075/ijomeh.1896.02227 -
The Journal of Allergy and Clinical... Aug 2023This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following... (Review)
Review
Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach.
This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.
Topics: Humans; COVID-19 Vaccines; GRADE Approach; Consensus; Vaccine Excipients; COVID-19; Hypersensitivity, Immediate; Anaphylaxis; Excipients
PubMed: 37295474
DOI: 10.1016/j.jaci.2023.05.019 -
Journal of Clinical Medicine Jul 2023Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases with probably differential underlying physiopathology. Despite the revolutionary era of... (Review)
Review
Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases with probably differential underlying physiopathology. Despite the revolutionary era of biologics, some patients remain difficult to treat because of disease severity, drug adverse events, drug allergy or association with severe comorbidities, i.e., uveitis, interstitial lung disease and macrophagic activation syndrome. Janus Kinase (JAK) inhibitors are small molecules that target JAK/Signal Transducers and Activators of Transcription (STAT) pathways, which could then prevent the activity of several proinflammatory cytokines. They may provide a useful alternative in these cases of JIA or in patients actually affected by Mendelian disorders mimicking JIA, such as type I interferonopathies with joint involvement, and might be the bridge for haematopoietic stem cell transplantation in these disabling conditions. As these treatments may have side effects that should not be ignored, ongoing and further controlled studies are still needed to provide data underlying long-term safety considerations in children and delineate subsets of JIA patients that will benefit from these promising treatments.
PubMed: 37510809
DOI: 10.3390/jcm12144695 -
The Journal of Experimental Medicine Jul 2023While group-2 innate lymphoid cells (ILC2s) are highly proliferative in allergic inflammation, the removal of overactivated ILC2s in allergic diseases has not been...
While group-2 innate lymphoid cells (ILC2s) are highly proliferative in allergic inflammation, the removal of overactivated ILC2s in allergic diseases has not been investigated. We previously showed that chronic airway allergy induces "exhausted-like" dysfunctional ILC2s expressing T cell immunoreceptor with Ig and ITIM domains (TIGIT). However, the physiological relevance of these cells in chronic allergy remains elusive. To precisely identify and monitor TIGIT+ ILC2s, we generated TIGIT lineage tracer mice. Chronic allergy stably induced TIGIT+ ILC2s, which were highly activated, apoptotic, and were quickly removed from sites of chronic allergy. Transcripts from coding genes were globally suppressed in the cells, possibly due to reduced chromatin accessibility. Cell death in TIGIT+ ILC2s was enhanced by interactions with CD155 expressed on macrophages, whereas genetic ablation of Tigit or blockade by anti-TIGIT antagonistic antibodies promoted ILC2 survival, thereby deteriorating chronic allergic inflammation. Our work demonstrates that TIGIT shifts the fate of ILC2s toward activation-induced cell death, which could present a new therapeutic target for chronic allergies.
Topics: Animals; Mice; Cell Death; Hypersensitivity; Immunity, Innate; Inflammation; Lymphocytes; Receptors, Immunologic
PubMed: 37036426
DOI: 10.1084/jem.20222005 -
Danish Medical Journal Aug 2023About 10% of hospital inpatients are labelled with penicillin allergy in their electronic medical record (EMR). However, allergy is confirmed in less than 10% of these...
INTRODUCTION
About 10% of hospital inpatients are labelled with penicillin allergy in their electronic medical record (EMR). However, allergy is confirmed in less than 10% of these records. Consequently, 90% of patients are treated with broad-spectrum antibiotics, contributing to antimicrobial resistance. We aimed to explore experiences and practices of healthcare professionals that may explain incorrect labelling of penicillin allergy in Denmark and elucidate any consequences hereof.
METHODS
An electronic survey was distributed to physicians and nurses in six hospital units in Copenhagen and via social media. The survey was active from 19 March to 1 May 2020. Data were assessed using descriptive statistics and by thematic analysis.
RESULTS
The response rate was 44.6%. The survey had 369 participants; 152 physicians and 217 nurses. Half of the physicians and one in every five nurses had experienced problems treating patients with a penicillin allergy label. Physicians reported limited trust in allergy labels, and labelling practices varied. The risk that patients may be truly allergic was the main reason for not removing labels (72%), and a precautionary principle was identified related to penicillin allergy labelling.
CONCLUSIONS
The penicillin allergy label is an independent factor of medication errors. Solutions to enhance patient safety may include education of physicians in allergy labelling, decision support, standardisation of the allergy registration in the various EMR systems used, and ideally also a national drug allergy register, which is accessible from all sectors.
FUNDING
None.
TRIAL REGISTRATION
Not relevant.
Topics: Humans; Drug Hypersensitivity; Hypersensitivity; Anti-Bacterial Agents; Attitude of Health Personnel; Penicillins
PubMed: 37622646
DOI: No ID Found -
Frontiers in Medicine 2023
PubMed: 37942420
DOI: 10.3389/fmed.2023.1305765