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General Dentistry 2019Penicillin allergy, local anesthetic hypersensitivity, latex allergy, contact hypersensitivity, and anaphylaxis are among the allergic reactions encountered in dental... (Review)
Review
Penicillin allergy, local anesthetic hypersensitivity, latex allergy, contact hypersensitivity, and anaphylaxis are among the allergic reactions encountered in dental practice. This article reviews the literature pertaining to these important areas of overlap between dentistry and allergy/immunology. The epidemiology, diagnosis, and management of penicillin allergy as it relates to dentistry are reviewed. The relevant literature regarding local anesthetic and latex hypersensitivity is discussed. In addition, the presentation, evaluation, and management of contact hypersensitivity, including that to metals, are addressed. Recognition and appropriate treatment of anaphylaxis also are reviewed. This article will help dentists understand potential areas of comanagement with allergists/immunologists to optimize patient care.
Topics: Dentistry; Dentists; Dermatitis, Allergic Contact; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Latex Hypersensitivity
PubMed: 31355763
DOI: No ID Found -
Der Internist Aug 2019Acute interstitial nephritis (AIN) is a rare, often underdiagnosed condition and a common cause of renal failure. Drugs are the leading cause. The underlying...
Acute interstitial nephritis (AIN) is a rare, often underdiagnosed condition and a common cause of renal failure. Drugs are the leading cause. The underlying pathophysiological condition is often a type IV hypersensitivity reaction. There are also rarer idiopathic forms, which often remain unrecognized. Additionally, the pathophysiological mechanisms are poorly understood, so that only very few promising forms of treatment are available. For some medications the overall risk is low but the side effects are relevant for the clinical routine due to the fact that they are frequently prescribed. In addition, the development of new approaches, such as immunotherapy also leads to side effects that cannot be completely predicted. For many diseases the occurrence of acute kidney injury increases the mortality and morbidity. A potentially irreversible chronic renal failure increases the incidence of further comorbidities and reduces the quality of life. Treatment is difficult and mostly empirical.
Topics: Acute Kidney Injury; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity, Delayed; Nephritis, Interstitial; Quality of Life; Renal Insufficiency, Chronic
PubMed: 31286163
DOI: 10.1007/s00108-019-0634-3 -
Allergy and Asthma Proceedings Jan 2022Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because... (Review)
Review
Recent advances in vaccination against the severe acute respiratory syndrome coronavirus 2 pandemic have brought allergists and dermatologists to the forefront because both immediate and delayed hypersensitivity reactions have been reported. This literature review focused on delayed reactions to vaccines, including possible causative agents and practical information on how to diagnose, evaluate with patch testing, and manage subsequent dose administration. Currently published reviews and case reports in PubMed, along with data on vaccines from the Centers for Disease Control and Prevention web site. Relevant case reports and reviews that focused on delayed reactions to vaccines were selected. Most delayed hypersensitivity reactions to vaccines include cutaneous manifestations, which vary from local persistent pruritic nodules to systemic rashes. The onset is usually within a few days but can be delayed by weeks. Multiple excipients have been identified that have been implicated in delayed vaccine reactions, including thimerosal, formaldehyde, aluminum, antibiotics, and gelatin. Treatment with antihistamines, topical corticosteroids, or systemic corticosteroids alleviates symptoms in most patients. Such reactions are generally not contraindications to future vaccination. However, for more-severe reactions, patch testing for causative agents can be used to aid in diagnosis and approach further vaccination. Delayed-type hypersensitivity reactions to vaccines are not uncommon. If needed, patch testing can be used to confirm agents, including antibiotics, formaldehyde, thimerosal, and aluminum. In most cases, delayed cutaneous reactions are not contraindications to further vaccine administration.
Topics: Adrenal Cortex Hormones; Aluminum; Anti-Bacterial Agents; COVID-19; Excipients; Formaldehyde; Humans; Hypersensitivity, Delayed; Thimerosal; United States; Vaccines
PubMed: 34983706
DOI: 10.2500/aap.2022.43.210105 -
Swiss Medical Weekly Feb 2023Corticosteroids, which are anti-inflammatory and immunosuppressive agents used for the treatment of various diseases including allergic disorders, can induce immediate... (Review)
Review
BACKGROUND
Corticosteroids, which are anti-inflammatory and immunosuppressive agents used for the treatment of various diseases including allergic disorders, can induce immediate and delayed hypersensitivity reactions. Although these reactions are not common, due to the wide usage of corticosteroid medications, corticosteroid hypersensitivity reactions are clinically important.
OBJECTIVE
In this review, we summarise the prevalence, pathogenetic mechanism, clinical manifestations, risk factors, diagnostic and therapeutic approach for corticosteroid-induced hypersensitivity reactions.
METHODS
An integrative review of the literature was conducted using PubMed searches (mainly large cohort-based studies) regarding the different aspects of corticosteroid hypersensitivity.
RESULTS
Hypersensitivity reactions to corticosteroids can be immediate or delayed and can follow all modes of corticosteroid administration. Prick and intradermal skin tests are useful diagnostic tools for immediate hypersensitivity reactions, patch tests are useful for delayed hypersensitivity reactions. According to the diagnostic tests an alternative (safe) corticosteroid agent should be administered.
CONCLUSION
Physicians of all medical disciplines should be aware that corticosteroids can cause (paradoxically) immediate or delayed allergic hypersensitivity reactions. The diagnosis of such allergic reactions is challenging since it is often difficult to distinguish between hypersensitivity reactions and deterioration of the basic inflammatory disease (e.g., worsening of asthma or dermatitis). Thus, a high index of suspicion is needed in order to identify the culprit corticosteroid.
Topics: Humans; Prevalence; Drug Hypersensitivity; Adrenal Cortex Hormones; Hypersensitivity, Immediate; Hypersensitivity, Delayed; Skin Tests
PubMed: 36800886
DOI: 10.57187/smw.2023.40025 -
Allergy Jan 2023Virus infections and T-cell-mediated drug hypersensitivity reactions (DHR) can influence each other. In most instances, systemic virus infections appear first. They may... (Review)
Review
Virus infections and T-cell-mediated drug hypersensitivity reactions (DHR) can influence each other. In most instances, systemic virus infections appear first. They may prime the reactivity to drugs in two ways: First, by virus-induced second signals: certain drugs like β-lactam antibiotics are haptens and covalently bind to various soluble and tissue proteins, thereby forming novel antigens. Under homeostatic conditions, these neo-antigens do not induce an immune reaction, probably because co-stimulation is missing. During a virus infection, the hapten-modified peptides are presented in an immune-stimulatory environment with co-stimulation. A drug-specific immune reaction may develop and manifest as exanthema. Second, by increased pharmacological interactions with immune receptors (p-i): drugs tend to bind to proteins and may even bind to immune receptors. Without viral infections, this low affine binding may be insufficient to elicit T-cell activation. During a viral infection, immune receptors are more abundantly expressed and allow more interactions to occur. This increases the overall avidity of p-i reactions and may even be sufficient for T-cell activation and symptoms. There is a situation where the virus-DHR sequence of events is inversed: in drug reaction with eosinophilia and systemic symptoms (DRESS), a severe DHR can precede reactivation and viremia of various herpes viruses. One could explain this phenomenon by the massive p-i mediated immune stimulation during acute DRESS, which coincidentally activates many herpes virus-specific T cells. Through p-i stimulation, they develop a cytotoxic activity by killing herpes peptide-expressing cells and releasing herpes viruses. These concepts could explain the often transient nature of DHR occurring during viral infections and the often asymptomatic herpes-virus viraemia after DRESS.
Topics: Humans; Drug Hypersensitivity; Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Hypersensitivity, Delayed; Virus Diseases; Drug Hypersensitivity Syndrome
PubMed: 36264263
DOI: 10.1111/all.15558 -
Medicina Clinica Apr 2020
Topics: Erythema Nodosum; Humans; Sarcoidosis; Sarcoidosis, Pulmonary
PubMed: 31427151
DOI: 10.1016/j.medcli.2019.05.039 -
Immunology and Allergy Clinics of North... May 2022In evaluating adverse drug reactions (ADRs), patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) are useful tools for identifying responsible drugs... (Review)
Review
In evaluating adverse drug reactions (ADRs), patch tests (PTs), skin prick tests (SPTs), and intradermal tests (IDTs) are useful tools for identifying responsible drugs and finding safe alternatives. Their diagnostic value depends on the clinical features of the ADR and on the drug tested. PTs have a good sensitivity in assessing acute generalized exanthematous pustulosis and drug rash with eosinophilia and systemic symptoms. SPTs done with all drugs except opiates are used for immediate hypersensitivity reactions. IDTs seem sensitive for immediate hypersensitivity reactions to beta-lactam antibiotics, iodinated contrast media, heparins, general anesthetics, and platinum salts.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Patch Tests; Skin Tests
PubMed: 35469620
DOI: 10.1016/j.iac.2022.01.003 -
Immunology and Allergy Clinics of North... Aug 2021Protein contact dermatitis is a cutaneous hypersensitivity reaction after chronic, recurrent exposure or chronic irritation to animal or plant protein. Although the... (Review)
Review
Protein contact dermatitis is a cutaneous hypersensitivity reaction after chronic, recurrent exposure or chronic irritation to animal or plant protein. Although the pathophysiological mechanisms underlying protein contact dermatitis are not well characterized, protein contact dermatitis is thought to be caused by combined type I/IV-mediated, type-1 mediated, or a Langerhans cell immunoglobulin E-mediated delayed hypersensitivity reaction. This chapter reviews the epidemiology, pathogenesis, clinical features, common protein allergens, diagnostic process, treatment options, and prognosis of protein contact dermatitis.
Topics: Allergens; Animals; Dermatitis, Allergic Contact; Dermatitis, Atopic; Dermatitis, Contact; Humans; Immunoglobulin E; Urticaria
PubMed: 34225902
DOI: 10.1016/j.iac.2021.04.008 -
Optometry and Vision Science : Official... Apr 2022Tattoo-associated uveitis describes simultaneous tattoo inflammation and uveitis. Multiple cases exist in the literature related to systemic sarcoidosis or a delayed...
SIGNIFICANCE
Tattoo-associated uveitis describes simultaneous tattoo inflammation and uveitis. Multiple cases exist in the literature related to systemic sarcoidosis or a delayed hypersensitivity reaction; however, there is no consensus on etiology. Clinicians should consider new tattoos as an associated factor for patients presenting with a new uveitis.
PURPOSE
In this retrospective review case series, two African American men with simultaneous tattoo inflammation and bilateral anterior uveitis were examined. Systemic sarcoidosis was suspected as the leading differential in both cases; however, laboratory evidence and imaging did not confirm a sarcoidosis diagnosis. Both patients were therefore suspected to have tattoo-associated uveitis.
CASE REPORTS
Acute anterior uveitis was diagnosed in 24- and 42-year-old African American men who presented with bilateral uveitis and inflammation of tattoos received greater than 1 year before the onset of symptoms. One patient presented with granulomatous ocular signs, whereas the other did not. Both patients received skin biopsies of their tattoos confirming noncaseating granulomas. Both patients had unremarkable radiological chest scans and were treated with topical and oral corticosteroids but only had complete inflammatory resolution after removal of their tattoos. After tattoo removal, neither patient experienced recurrent inflammation.
CONCLUSIONS
Simultaneous tattoo granuloma and uveitis is well supported by literature evidence. It is suspected that both patients either had a localized sarcoidosis reaction or had tattoo-associated uveitis due to a delayed-type hypersensitivity reaction caused by an unknown antigen in the tattoo ink.
Topics: Adult; Granuloma; Humans; Male; Sarcoidosis; Tattooing; Uveitis; Uveitis, Anterior; Young Adult
PubMed: 35001066
DOI: 10.1097/OPX.0000000000001859 -
British Journal of Clinical Pharmacology Dec 2019Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent... (Review)
Review
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
Topics: Guillain-Barre Syndrome; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Immunocompromised Host; Immunoglobulin E; Skin Tests; T-Lymphocytes; Vaccination; Vaccine Excipients; Vaccines
PubMed: 31472022
DOI: 10.1111/bcp.14112