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Handbook of Experimental Pharmacology 2022Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type...
Allergy or hypersensitivity to drugs often affects the skin and sometimes also mucosa. While immediate type reactions show a rather homogeneous pattern, delayed type reactions reveal a high variability. In both cases it may not always be easy to differentiate drug reactions from non-drug-induced skin conditions. Furthermore, the different types of cutaneous adverse reactions may be difficult to distinguish in the beginning. This accounts predominately for delayed hypersensitivity reactions that can occur after a variety of medications and present with manifold lesions. Most of these cutaneous adverse reactions are mild, but some are severe with high morbidity and mortality. In the clinical setting, it is important to recognize the signs that point to a more severe condition early on in order to initiate appropriate management. In addition, it is crucial to identify the potentially culprit medication on the basis of a detailed medication history and by evaluating the relevant exposure times of certain drugs that differ substantially between the various reaction types. After the acute stage of the adverse reaction is managed successfully, further allergologic testing may be undertaken to confirm the offending drug.
Topics: Drug Hypersensitivity; Humans; Skin; Skin Tests
PubMed: 34219202
DOI: 10.1007/164_2021_490 -
Current Opinion in Pulmonary Medicine Sep 2021The current review summarizes recent guidance in the diagnosis and management of sarcoidosis. Until recently, the main guidelines were the 1999 International Statement... (Review)
Review
PURPOSE OF REVIEW
The current review summarizes recent guidance in the diagnosis and management of sarcoidosis. Until recently, the main guidelines were the 1999 International Statement on Sarcoidosis. However, in 2020 two new guidelines were published by the American and British Thoracic Societies. They have a number of key updates and this review aims to summarize these.
RECENT FINDINGS
The key findings from 2020 revolve around several themes. First, the need for a histological diagnosis should be supported by a multidisciplinary team approach. When a histological biopsy is needed of the lungs, thought is given to the approach taken for this and to whether an endobronchial ultrasound, endoscopic ultrasound or transbronchial biopsy is needed. Second, information regarding supporting tests including blood biomarkers, lung function and imaging. Third, a section specific to cardiac sarcoidosis. Finally, a summary of guidance for treating sarcoidosis including the need to treat fatigue.
SUMMARY
The recent guidance suggests that a histological biopsy is only needed in cases of diagnostic uncertainty or in patients with typical long standing features on imaging. The guidelines also provide a clear pathway on the type of lung biopsy needed depending on the extent of mediastinal or parenchymal involvement. Support is given to steroid regimens and indication for second-line immunosuppression.
Topics: Biopsy; Bronchoscopy; Endosonography; Humans; Sarcoidosis; Sarcoidosis, Pulmonary
PubMed: 34261085
DOI: 10.1097/MCP.0000000000000807 -
Pediatric Allergy and Immunology :... Apr 2021Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate... (Review)
Review
BACKGROUND
Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening.
AIM
This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature.
RESULTS
Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids.
CONCLUSION
Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.
Topics: Anticonvulsants; Child; Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Intradermal Tests; Risk Factors; Skin
PubMed: 33205474
DOI: 10.1111/pai.13409 -
The Journal of the Royal College of... Sep 2020Sarcoidosis remains difficult to diagnose, assess and treat. The last decade has brought significant diagnostic and therapeutic advances in the field of sarcoidosis... (Review)
Review
Sarcoidosis remains difficult to diagnose, assess and treat. The last decade has brought significant diagnostic and therapeutic advances in the field of sarcoidosis including endobronchial ultrasound, F-fluorodeoxyglucose positron emission tomography and biologics. In this article we use clinical vignettes to discuss commonly encountered cases to illustrate and explain the application of these, and other advances.
Topics: Fluorodeoxyglucose F18; Humans; Positron-Emission Tomography; Radiopharmaceuticals; Sarcoidosis; Sarcoidosis, Pulmonary
PubMed: 32936114
DOI: 10.4997/JRCPE.2020.324 -
The Journal of Family Practice Oct 2023
Topics: Humans; Dermatitis, Allergic Contact
PubMed: 37862625
DOI: 10.12788/jfp.0678 -
The Journal of Allergy and Clinical... 2019Large health system databases have revolutionized our understanding of the epidemiology of adverse drug reactions and immunologically mediated drug hypersensitivity.... (Review)
Review
Large health system databases have revolutionized our understanding of the epidemiology of adverse drug reactions and immunologically mediated drug hypersensitivity. Population-based background rates of newly reported drug intolerance with each therapeutic exposure could not have been determined without large health system databases. Large databases have increased our understanding of multiple drug intolerance syndrome. Large health care systems, such as Kaiser Permanente, with a single electronic medical record system that covers all inpatient, outpatient, and pharmacy interactions, are particularly valuable in understanding the population-based incidence of severe and nonsevere adverse drug reactions, the risks of delayed-onset adverse drug reactions, such as those caused by Clostridiodes difficile, which can occur months after antibiotic exposures, and the risks and benefits associated with "allergy" delabeling, specifically penicillin allergy delabeling, which may accrue in the years after the delabeling. There currently are limitations to using electronic data, specifically billing code data, when studying adverse drug reactions. It is critical to audit electronic health records, which have temporally associated the use of a drug and an adverse reaction because of high rates of miscoding or lack of true cause and effect. Pending improvements in drug hypersensitivity coding in International Classification of Diseases, Eleventh Revision may make large databases even more useful.
Topics: Anti-Bacterial Agents; Data Accuracy; Data Collection; Databases, Factual; Delivery of Health Care; Documentation; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Electronic Health Records; Humans; Incidence; International Classification of Diseases; Penicillins; Stevens-Johnson Syndrome; Sulfonamides
PubMed: 31495422
DOI: 10.1016/j.jaip.2019.04.014 -
Expert Review of Clinical Immunology Jun 2020Allergic contact dermatitis is an inflammatory skin disease which accounts for up to 20% of all childhood dermatitis. Childhood allergic contact dermatitis is more... (Review)
Review
INTRODUCTION
Allergic contact dermatitis is an inflammatory skin disease which accounts for up to 20% of all childhood dermatitis. Childhood allergic contact dermatitis is more frequent than previously thought and today early diagnosis is considered very important. Patch testing represents the gold standard method used to confirm the diagnosis of allergic contact dermatitis. The knowledge of the most common allergens involved in allergic contact dermatitis in pediatric age is important considering that the first-line management of allergic contact dermatitis in children is to avoid the involved allergens.
AREAS COVERED
We reviewed the literature on PubMed® and SciVerse Scopus® medical database about allergic contact dermatitis and emerging contact allergens in children. In this review, we summarize the clinical characteristics, differential diagnoses, and epidemiology of allergic contact dermatitis in children, underlying the most recent pieces of evidence about the most frequent and emerging contact allergens.
EXPERT OPINION
We believe that persistent, well localized and recurrent eczematous lesions in children should suggest an allergic contact dermatitis, inducing physicians to refer patients for patch testing. Physicians should be acquainted with the current trends and the emerging contact allergens in children, in order to provide not only the best treatment but also the best management and prevention.
Topics: Child; Dermatitis, Allergic Contact; Diagnosis, Differential; Humans; Patch Tests
PubMed: 32490693
DOI: 10.1080/1744666X.2020.1777858 -
Dermatitis : Contact, Atopic,... 2023Although allergic contact dermatitis is a type IV hypersensitivity reaction, type I hypersensitivity reactions, such as anaphylaxis, have been reported during patch... (Review)
Review
Although allergic contact dermatitis is a type IV hypersensitivity reaction, type I hypersensitivity reactions, such as anaphylaxis, have been reported during patch testing. The aim of this study was to identify reported cases of anaphylaxis from patch testing and estimate its rate. A literature review was conducted on PubMed to identify previously reported cases of anaphylaxis after patch testing and suspected allergens. In addition, a survey was distributed to expert patch testing dermatologists to determine the rate of anaphylaxis after patch testing. Three anaphylaxis cases due to patch testing were found in the literature. Twenty-seven of 36 expert patch testers completed the survey for a 75% response rate. These dermatologists have tested an estimated 201,720 patients in their combined careers. From them, 2 cases of patch test anaphylaxis were reported. The rate of anaphylaxis from patch testing was calculated to be 1 in 100,860 tests among our cohort. Patch testing induced anaphylaxis is rare and may be more likely in patients with a history of anaphylaxis. Although rare, dermatologists should have a management plan in place.
Topics: Humans; Patch Tests; Anaphylaxis; Dermatitis, Allergic Contact; Allergens; Hypersensitivity, Delayed
PubMed: 36705647
DOI: 10.1089/DERM.0000000000000956 -
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 -
European Annals of Allergy and Clinical... Jul 2021Different clinical pictures are related to corticosteroids (CS) non immediate hypersensitivity and the frequency of these reactions can be underestimated. The...
Different clinical pictures are related to corticosteroids (CS) non immediate hypersensitivity and the frequency of these reactions can be underestimated. The classification of CS in 3 groups and the identification of two patient's profiles has been proposed by Baeck to help clinicians in the management of these cases. Data of 14 patients with clinical history of delayed reactions to various CS and positive skin test and/or oral challenge are retrospectively analyzed. Three different patterns of patients are identified evaluating history, clinical picture and tests results. The first one (6 pts, 43%) is characterized by cutaneous and/or mucosal reaction due to inhaled Budesonide and patch test positive only to topical molecules belonging to the group 1 of CS. The second pattern (4 pts) has clinical history of local and systemic skin reactions to the topic and parenteral administration of the same or other steroid drugs. Patients belonging to the third pattern (4 pts) have a history of systemic reactions to general administration of CS without previous contact reaction. Pattern 2 and 3 show a wide sensitization to molecules belonging to the 3 groups of CS. All the patients show patch test positive to Budesonide. Although the lack of standardization, the allergy workup proves useful to differentiate patients sensitized to one or few molecules from polysensitized and to identify the culprit drugs. Intradermal and challenge test are necessary to complete the diagnostic workup. The results suggest the possibility of a different management of patients. Patients of pattern one can be only patch tested with a limited series of CS belonging to the 3 groups. They don't need an extensive exclusion of steroids use. The pattern 2 and 3 must be submitted instead to a complete allergological individual evaluation to identify alternative tolerated drugs, because of the risk of systemic reactions. The Baeck's classification shows limited usefulness in these cases.
Topics: Adrenal Cortex Hormones; Adult; Budesonide; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Delayed; Male; Middle Aged; Patch Tests; Retrospective Studies; Young Adult
PubMed: 32729318
DOI: 10.23822/EurAnnACI.1764-1489.164