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Dermatitis : Contact, Atopic,...Clinical trials are currently underway to evaluate the benefit of dupilumab in treating allergic contact dermatitis (ACD). Dupilumab use has been reported to improve ACD... (Review)
Review
Clinical trials are currently underway to evaluate the benefit of dupilumab in treating allergic contact dermatitis (ACD). Dupilumab use has been reported to improve ACD reactions in some patients, but not all. Varying clinical responses to T helper 2 (TH2) inhibition challenge the classical view that ACD proceeds through a TH1-dominant pathway. Selective TH2 inhibitors, such as dupilumab, may attenuate ACD when the delayed hypersensitivity response is due to TH2-predominate activation; conversely, it may have no effect on ACD if it is elicited via TH1 or TH17 pathways. We hypothesize that allergen-specific T-cell responses and patient-specific factors both play an important role in determining which pathways are recalled in delayed hypersensitivity reactions.
Topics: Allergens; Antibodies, Monoclonal, Humanized; Dermatitis, Allergic Contact; Humans; Th1 Cells; Th17 Cells; Th2 Cells
PubMed: 32496280
DOI: 10.1097/DER.0000000000000616 -
The Medical Journal of Malaysia May 2022Renal involvement in sarcoidosis is very uncommon and often diagnosed through renal biopsy. It is a chronic and multisystem disease with unknown aetiology and can affect...
Renal involvement in sarcoidosis is very uncommon and often diagnosed through renal biopsy. It is a chronic and multisystem disease with unknown aetiology and can affect all organs of the body with strong predilection to the lungs. Although glucocorticoids are effective in the treatment of sarcoidosis, the mainstay of management includes supportive hydration and prevention of nephrotoxins. We report a case of a young man who was admitted with an ocular and renal impairment secondary to sarcoidosis.
Topics: Glucocorticoids; Humans; Kidney; Male; Sarcoidosis
PubMed: 35638496
DOI: No ID Found -
Drug Safety Aug 2019Cutaneous adverse drug reactions are unpredictable and include various different skin conditions of varying degrees of severity. The most concerning are usually referred... (Review)
Review
Cutaneous adverse drug reactions are unpredictable and include various different skin conditions of varying degrees of severity. The most concerning are usually referred to as severe cutaneous adverse reactions (SCARs) and include acute generalized exanthematous pustulosis (AGEP), drug reaction with eosinophilia and systemic symptoms (DRESS), also known as drug-induced hypersensitivity syndrome (DiHS) or hypersensitivity syndrome (HSS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). All are delayed type IV hypersensitivity reactions in which a T-cell-mediated drug-specific immune response is responsible for causing the disease. Nonetheless, specific T-cell subpopulations develop in response to certain environmental conditions and produce cytokines that orchestrate the various phenotypes. Cytotoxic T lymphocytes (CTLs), T-helper type 1 (Th1), Th2, Th17, and regulatory T cells (Treg), among other T-cell subpopulations, participate in the development of SCAR phenotypes. Cell subpopulations belonging to the innate immune system, comprising natural killer cells, innate lymphoid cells, monocytes, macrophages and dendritic cells, can also participate in shaping specific immune responses in various clinical conditions. Additionally, tissue-resident cells, including keratinocytes, can contribute to epidermal damage by secreting chemokines that attract pro-inflammatory immunocytes. The final phenotypes in each clinical entity result from the complex interactions between a variety of cell lineages, their products, soluble mediators and genetic and environmental factors. Although the pathophysiology of these reactions is not fully understood, intensive research in recent years has led to major progress in our understanding of the contribution of certain cell types and soluble mediators to the variability of SCAR phenotypes.
Topics: Acute Generalized Exanthematous Pustulosis; Animals; Drug Eruptions; Drug Hypersensitivity Syndrome; Humans; Immunity, Innate
PubMed: 31020549
DOI: 10.1007/s40264-019-00825-2 -
Pediatrics May 2020Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1... (Review)
Review
Nickel is a ubiquitous metal added to jewelry and metallic substances for its hardening properties and because it is inexpensive. Estimates suggest that at least 1.1 million children in the United States are sensitized to nickel. Nickel allergic contact dermatitis (Ni-ACD) is the most common cutaneous delayed-type hypersensitivity reaction worldwide. The incidence among children tested has almost quadrupled over the past 3 decades. The associated morbidities include itch, discomfort, school absence, and reduced quality of life. In adulthood, individuals with Ni-ACD may have severe disabling hand eczema. The increasing rate of Ni-ACD in children has been postulated to result from early and frequent exposure to metals with high amounts of nickel release (eg, as occurs with ear piercing or with products used daily in childhood such as toys, belt buckles, and electronics).To reduce exposure to metal sources with high nickel release by prolonged and direct contact with human skin, Denmark and the European Union legislated a directive several decades ago with the goal of reducing high nickel release and the incidence of Ni-ACD. Since then, there has been a global reduction in incidence of Ni-ACD in population-based studies of adults and studies of children and young adults being tested for allergic contact dermatitis. These data point to nickel exposure as a trigger for elicitation of Ni-ACD and, further, provide evidence that legislation can have a favorable effect on the economic and medical health of a population.This policy statement reviews the epidemiology, history, and appearances of Ni-ACD. Examples of sources of high nickel release are discussed to highlight how difficult it is to avoid this metal in modern daily lives. Treatments are outlined, and avoidance strategies are presented. Long-term epidemiological interventions are addressed. Advocacy for smarter nickel use is reviewed. The American Academy of Pediatrics supports US legislation that advances safety standards (as modeled by the European Union) that protect children from early and prolonged skin exposure to high-nickel-releasing items. Our final aim for this article is to aid the pediatric community in developing nickel-avoidance strategies on both individual and global levels.
Topics: Administration, Topical; Anti-Inflammatory Agents; Dermatitis, Allergic Contact; Environmental Exposure; Humans; Nickel; Patch Tests; Treatment Outcome
PubMed: 32341178
DOI: 10.1542/peds.2020-0628 -
Chemico-biological Interactions Dec 2022Pseurotins, secondary metabolites of fungi, represent a group of bioactive natural products with newly recognized biological activities, including the modulation of...
Pseurotins, secondary metabolites of fungi, represent a group of bioactive natural products with newly recognized biological activities, including the modulation of specific immune response. However, the type of immune response affected by pseurotins and the mechanistic details underlying these effects are still not understood. Thus, the aim of the current study was to examine the effects of pseurotin D on delayed-type IV hypersensitivity (DTH) reaction induced by chicken ovalbumin in vivo and to examine the effects of pseurotin D on major types of leukocytes responsible for DTH development in vitro. Pseurotin D significantly decreased paw swelling, the major symptom of DTH, as well as the DTH-related production of pro-inflammatory cytokine IL-1β, IL-4, IL-6, IFN-γ and anti-inflammatory cytokine IL-10 in paws tissue, spleen enlargement, and DTH-related changes in leukocyte counts in peripheral blood. In vitro, pseurotin D mediated a decrease in the proliferation and differentiation of both Th1 and Th2 cells, as was concluded on the basis of the inhibition of the gene expressions of Gata3 and Tbx21 and the production of effector cytokines IFN-γ and IL-13 in vitro. Further, pseurotin D significantly inhibited the activation and differentiation of B cells, as was documented by the significant inhibition of B cell proliferation, CD138 expression, and IgE production. In conclusion, the results show the potential of pseurotin D to inhibit DTH reaction, this phenomenon involving the inhibition of the activation and differentiation of both T cells and B cells.
Topics: Humans; Hypersensitivity, Delayed; Th2 Cells; Cytokines; Interferon-gamma
PubMed: 36349590
DOI: 10.1016/j.cbi.2022.110241 -
Pediatric Allergy and Immunology :... Aug 2019Antiepileptic drugs (AEDs) can cause hypersensitivity reactions in children. These reactions are mainly cutaneous, self-limiting, and benign, but life-threatening severe...
BACKGROUND
Antiepileptic drugs (AEDs) can cause hypersensitivity reactions in children. These reactions are mainly cutaneous, self-limiting, and benign, but life-threatening severe cutaneous adverse reactions can occur. Infections can lead to skin eruptions and mimic drug hypersensitivity reactions, if a drug is taken at the same time. The aims of our study were to confirm or rule out the diagnosis of hypersensitivity reactions to AEDs in children and to detect an infection which mimics these reactions.
METHODS
A prospective survey was conducted in a group of 100 children with histories of hypersensitivity reactions to AEDs by performing patch tests, delayed-reading intradermal test, and, in case of negative results, challenge test. In all children, a study was performed to detect infections by viruses or Mycoplasma pneumoniae.
RESULTS
Maculopapular exanthema and delayed-appearing urticaria were the most reported hypersensitivity reactions to AEDs. Sixty-six (66%) of 100 children had confirmed hypersensitivity reactions to AEDs. Fifty-nine children had positive patch test. No children had positive challenge tests. The most common AEDs causing hypersensitivity reactions were carbamazepine (45.4%) and lamotrigine (43.6%). Thirty-two children had positive tests for viruses or M pneumoniae, and nine of them had also a positive allergy work-up.
CONCLUSION
Considering that there are no specific tests to distinguish between a viral infection and hypersensitivity reactions to AEDs in the acute phase, a diagnostic work-up should be performed in all children with suspected hypersensitivity reactions to AEDs, as well as infectious agent study, to remove a false label of hypersensitivity.
Topics: Adolescent; Allergens; Anticonvulsants; Carbamazepine; Child; Child, Preschool; Diagnosis, Differential; Drug Hypersensitivity; Exanthema; Female; Humans; Hypersensitivity, Delayed; Infant; Lamotrigine; Male; Mycoplasma pneumoniae; Pneumonia, Mycoplasma; Prospective Studies; Serbia; Skin Tests; Virus Diseases
PubMed: 30951222
DOI: 10.1111/pai.13055 -
Boletin Medico Del Hospital Infantil de... 2022Acute generalized exanthematous pustulosis is a rare disease. Although it is usually related to drug intake, it is occasionally associated with infections, especially in...
BACKGROUND
Acute generalized exanthematous pustulosis is a rare disease. Although it is usually related to drug intake, it is occasionally associated with infections, especially in the pediatric age. It is characterized by the sudden onset of sterile non-follicular pustules on an erythematous fundus, fever, and leukocytosis, with frequent and prompt spontaneous resolution. It mainly affects adults and is uncommon in childhood. Complications have been reported in approximately 20% of cases.
CASE REPORT
We report the case of a 10-year-old female patient with a 5-day history of fever and dermatosis characterized by countless non-follicular pustules, predominantly on the trunk, inguinal folds, and proximal thighs but not involving palms, soles, and mucous membranes. The patient reported an incident of upper respiratory tract infection that occurred 7 days earlier. Histopathological examination confirmed the diagnosis of acute generalized exanthematous pustulosis. Spontaneous resolution occurred within 2 weeks.
CONCLUSIONS
This disease is one of the severe cutaneous adverse reactions that usually have a self-limited and benign course within a few weeks. We propose that a previous respiratory infection triggered the acute generalized exanthematous pustulosis in this pediatric case. Knowledge of this pathology by the medical professionals, in general, and the pediatricians, in particular, will prevent an aggressive and inappropriate approach and management.
Topics: Acute Generalized Exanthematous Pustulosis; Adult; Child; Female; Humans
PubMed: 36100209
DOI: 10.24875/BMHIM.21000125 -
Acta Chirurgica Belgica Jun 2023Sarcoidosis is a multi-system, idiopathic, inflammatory disorder that affects the lungs in over 90% of patients. The incidence of bone lesions in sarcoidosis is only...
BACKGROUND
Sarcoidosis is a multi-system, idiopathic, inflammatory disorder that affects the lungs in over 90% of patients. The incidence of bone lesions in sarcoidosis is only 1-13%.
CASE REPORT
This study describes a 60-year-old woman with a previous history of thyroid cancer, and a more recent diagnosis of lung cancer with suspicious metastatic lesions, which were confirmed to be sarcoidosis.
CONCLUSION
This case suggests that pulmonary neoplasms and pulmonary sarcoidosis can coexist and be easily confused. When lung cancer is accompanied by symmetric hilar lymph node enlargement and multiple lung nodules, sarcoidosis should be considered in addition to metastasis, and a biopsy should be performed for confirmation.
Topics: Female; Humans; Middle Aged; Sarcoidosis, Pulmonary; Sarcoidosis; Lung Neoplasms; Lung; Mediastinal Diseases
PubMed: 34753409
DOI: 10.1080/00015458.2021.2001900 -
The Journal of Allergy and Clinical... Aug 2019Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic... (Review)
Review
Many notable advances in drug allergy, urticaria, angioedema, and anaphylaxis were reported in 2018. Broad-spectrum antibiotic use and, consequently, antibiotic resistance are widespread, and algorithms to clarify β-lactam allergy and optimize antibiotic use were described. Meaningful data emerged on the pathogenesis of delayed drug hypersensitivity reactions. Progress not only in defining biomarkers but also in understanding the effect on quality of life and developing better treatments has been made for patients with chronic idiopathic urticaria. Patients with hereditary angioedema (HAE) have gained additional access to highly efficacious therapies, with associated improvements in quality of life, and some progress was made in our understanding of recurrent angioedema in patients with normal laboratory results. Guidelines have defined clear goals to help providers optimize therapies in patients with HAE. The epidemiology and triggers of anaphylaxis and the mechanisms underlying anaphylaxis were elucidated further. In summary, these disorders (and labels) cause substantial burdens for individual persons and even society. Fortunately, publications in 2018 have informed on advancements in diagnosis and management and have provided better understanding of mechanisms that potentially could yield new therapies. This progress should lead to better health outcomes and paths forward in patients with drug allergy, urticaria, HAE, and anaphylaxis.
Topics: Anaphylaxis; Angioedema; Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Quality of Life; Urticaria; beta-Lactams
PubMed: 31247266
DOI: 10.1016/j.jaci.2019.06.010 -
Current Opinion in Allergy and Clinical... Aug 2019Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive... (Review)
Review
PURPOSE OF REVIEW
Nonimmediate drug hypersensitivity reactions (NI-DHR) constitute the most complex group of drug allergy, with many drugs involved. Both parent drugs and their reactive metabolites can be implicated. Although with some drugs the number of metabolites is limited, with others it is quite extensive and many still remain to be identified. The diagnostic approaches are insufficient for the diagnosis and realistic approaches that reproduce the pathological response are lacking.
RECENT FINDINGS
A wider view has now been considered, with the inclusion of several mechanisms that may contribute to drug hypersensitivity reactions (DHR): the classical hapten hypothesis, the danger signal and the pharmacological interaction. Monitoring the acute response provides relevant information about the mechanisms involved, with the identification of a large number of genes that can be over-expressed or under-expressed in the acute phase of the response. Assessment of risk of developing reactions can be verified by HLA associations.
SUMMARY
Further knowledge of these NI-DHR, including molecular genetics and transcriptomic analysis, has enabled a better understanding and management of these reactions.
Topics: Allergens; Animals; Drug Hypersensitivity; Genetic Predisposition to Disease; HLA Antigens; Humans; Hypersensitivity, Delayed; Pathology, Molecular; Risk; T-Lymphocytes
PubMed: 31135394
DOI: 10.1097/ACI.0000000000000547