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Archives of Disease in Childhood May 2023
Topics: Humans; Penicillins; Drug Hypersensitivity; Hypersensitivity; Anti-Bacterial Agents
PubMed: 36963812
DOI: 10.1136/archdischild-2022-325200 -
Pediatric Allergy and Immunology :... May 2023
Topics: Humans; Child; Drug Hypersensitivity; Anti-Bacterial Agents
PubMed: 37232287
DOI: 10.1111/pai.13957 -
The Journal of Allergy and Clinical... Dec 2023There is no accepted grading system classifying the severity of immediate reactions to drugs.
BACKGROUND
There is no accepted grading system classifying the severity of immediate reactions to drugs.
OBJECTIVE
The purpose of this article is to present a proposed grading system developed through the consensus of drug allergy experts from the United States Drug Allergy Registry (USDAR) Consortium.
METHODS
The USDAR investigators sought to develop a consensus severity grading system for immediate drug reactions that is applicable to clinical care and research.
RESULTS
The USDAR grading scale scores severity levels on a scale of 0 to 4. A grade of no reaction (NR) is used for patients who undergo challenge without any symptoms or signs, and it would confirm a negative challenge result. A grade 0 reaction is indicative of primarily subjective complaints that are commonly seen with both historical drug reactions and during drug challenges, and it would suggest a low likelihood of a true drug allergic reaction. Grades 1 to 4 meet the criteria for a positive challenge result and may be considered indicative of a drug allergy. Grade 1 reactions are suggestive of a potential immediate drug reaction with mild symptoms. Grade 2 reactions are more likely to be immediate drug reactions of moderate severity. Grade 3 reactions have features suggestive of a severe allergic reaction, whereas grade 4 reactions are life-threatening reactions such as anaphylactic shock and fatal anaphylaxis.
CONCLUSION
This proposed grading schema for immediate drug reactions improves on prior schemata by being developed specifically for immediate drug reactions and being easy to implement in clinical and research practice.
Topics: Humans; United States; Skin Tests; Drug Hypersensitivity; Anaphylaxis; Hypersensitivity, Immediate; Anti-Bacterial Agents
PubMed: 37652140
DOI: 10.1016/j.jaci.2023.08.018 -
Expert Opinion on Biological Therapy Jan 2023Hypersensitivity reactions (HSRs) have been observed with the use of biologics in children. The management of HSRs in children is mainly based on experiences from the... (Review)
Review
INTRODUCTION
Hypersensitivity reactions (HSRs) have been observed with the use of biologics in children. The management of HSRs in children is mainly based on experiences from the adult population. Recently, data from different centers experienced in managing these reactions, including desensitization in children, have been published, allowing clinicians to have an appropriate global overview and compare results.
AREAS COVERED
This review highlights the published data on hypersensitivity reactions to biologics in children and drug desensitization protocols adapted to the pediatric population.
EXPERT OPINION
With regard to HSRs to biologics in children, few data are available. Compared with the adult population, there is a lack of knowledge in the endophenotypes, management and the standardization of protocols including premedication regimens in children. An international consensus is needed to provide clinicians with new insight on how to apply personalized management and to perform tailored desensitization protocols in pediatric populations. Various specialists including allergists, pediatricians, oncologists, hematologists, rheumatologists, and pharmacists, should build a multidisciplinary management team to keep pediatric patients on their best treatment options in the safest manner.
Topics: Adult; Humans; Child; Drug Hypersensitivity; Biological Products; Hypersensitivity; Desensitization, Immunologic
PubMed: 36314361
DOI: 10.1080/14712598.2022.2142039 -
Current Opinion in Allergy and Clinical... Aug 2020Omalizumab has been proposed for controlling adverse reactions during drug desensitization. Our aim is to know the current evidence involving the use of omalizumab in... (Review)
Review
PURPOSE OF REVIEW
Omalizumab has been proposed for controlling adverse reactions during drug desensitization. Our aim is to know the current evidence involving the use of omalizumab in drug-allergy desensitization.
RECENT FINDINGS
Drug-allergy desensitization is not risk free, but it is a useful procedure and has been applied for drug hypersensitivity reactions with mast cells degranulation through IgE and non-IgE mechanisms. Since 2007, omalizumab has been considered as a potential strategy to prevent adverse reactions.Our review found few case reports and only one randomized double-blind, placebo-controlled study, using different omalizumab regimens prior to drug desensitization. This scarce evidence is insufficient to predict the effectiveness of omalizumab in rapid drug desensitization procedures, but it may be useful in future studies of omalizumab or related next-generation antibodies.
SUMMARY
Omalizumab or other IgE-targeting biologics, either a fixed dose of 300 mg omalizumab or a dose-related total IgE level and body mass weight may be an option for patients with IgE-mediated or mast cell drug reactions in troublesome desensitization.
Topics: Anti-Allergic Agents; Biological Products; Desensitization, Immunologic; Dose-Response Relationship, Drug; Drug Hypersensitivity; Evidence-Based Medicine; Humans; Immunoglobulin E; Mast Cells; Omalizumab
PubMed: 32398420
DOI: 10.1097/ACI.0000000000000648 -
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 2021The true exanthematous reactions to drugs in children are rare and overdiagnosed. Drugs may cause exanthema either due to inducing an immune response or because of their... (Review)
Review
PURPOSE OF REVIEW
The true exanthematous reactions to drugs in children are rare and overdiagnosed. Drugs may cause exanthema either due to inducing an immune response or because of their interaction with viruses, if drugs are taken in the course of a viral infection. Also, viral infections are very often in children and they can provoke an exanthema which is difficult to differentiate from exanthematous reactions to drugs. Consequently, the majority of children are incorrectly labeled as 'allergic'.
RECENT FINDINGS
The correct diagnosis of exanthematous drug reactions in children is still an important and hot topic. Most information about the approach and management of drug hypersensitivity in children is applied from available guidelines and consensus statement for adults. Recently, a systematic clinical approach for timely differential diagnosis and management of rashes in children who present a cutaneous exanthema while receiving a drug, is proposed.
SUMMARY
It is important to consider the detailed clinical history of appearing and developing exanthematous drug reaction, as well as physical examination which includes the description and the distribution of exanthema and at the end making the appropriate diagnosis. Thus, it could reduce overdiagnosis and promote appropriate procedures, that will prevent the overlabeling of drug hypersensitivity in children.
Topics: Child; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Exanthema; Humans; Virus Diseases
PubMed: 33993141
DOI: 10.1097/ACI.0000000000000749 -
Journal Der Deutschen Dermatologischen... Oct 2022
Topics: Drug Hypersensitivity; Floods; Humans
PubMed: 36252063
DOI: 10.1111/ddg.14939 -
Current Opinion in Infectious Diseases Dec 2021The goal of this article is to provide an updated understanding and evidence-based approach where possible for antifungal hypersensitivity. This includes recognition of... (Review)
Review
PURPOSE OF REVIEW
The goal of this article is to provide an updated understanding and evidence-based approach where possible for antifungal hypersensitivity. This includes recognition of clinical phenotype, implications for cross-reactivity and diagnostic, and management strategy for immediate and delayed hypersensitivity reactions.
RECENT FINDINGS
Antifungal hypersensitivity reactions can be classified according to their latency (immediate or delayed) and clinical phenotype. The majority of the cases described in the literature are delayed T-cell mediated reactions of various severities but immediate reactions consistent with non-Immunoglobulin E (IgE)-mediated mast cell activation and IgE-mediated reactions have also been described. Ancillary information such as skin testing, drug challenge and ex vivo experimental approaches can aid causality assessments and inform antifungal class cross-reactivity, which help optimize antifungal prescribing and stewardship.
SUMMARY
This review will update the clinician on mechanisms of drug hypersensitivity as well as providing a structured approach to the recognition, diagnosis and management of antifungal hypersensitivity reaction.
Topics: Antifungal Agents; Cross Reactions; Drug Hypersensitivity; Humans; Immunoglobulin E; Skin Tests
PubMed: 34693920
DOI: 10.1097/QCO.0000000000000786 -
Journal of Immunological Methods Jun 2021
Topics: Drug Hypersensitivity; Humans
PubMed: 33684438
DOI: 10.1016/j.jim.2021.113004