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Allergy Jul 2013Drug hypersensitivity may deprive patients of drug therapy, and occasionally no effective alternative treatment is available. Successful desensitization has been well... (Review)
Review
Drug hypersensitivity may deprive patients of drug therapy, and occasionally no effective alternative treatment is available. Successful desensitization has been well documented in delayed drug hypersensitivity reactions. In certain situations, such as sulfonamide hypersensitivity in HIV-positive patients or hypersensitivity to antibiotics in patients with cystic fibrosis, published success rates reach 80%, and this procedure appears helpful for the patient management. A state of clinical tolerance may be achieved by the administration of increasing doses of the previously offending drug. However, in most cases, a pre-existent sensitization has not been proven by positive skin tests. Successful re-administration may have occurred in nonsensitized patients. A better understanding of the underlying mechanisms of desensitization is needed. Currently, desensitization in delayed hypersensitivity reactions is restricted to mild, uncomplicated exanthems and fixed drug eruptions. The published success rates vary depending on clinical manifestations, drugs, and applied protocols. Slower protocols tend to be more effective than rush protocols; however, underreporting of unsuccessful procedures is very probable. The decision to desensitize a patient must always be made on an individual basis, balancing risks and benefits. This paper reviews the literature and presents the expert experience of the Drug Hypersensitivity Interest Group of the European Academy of Allergy and Clinical Immunology.
Topics: Desensitization, Immunologic; Drug Hypersensitivity; Europe; Female; Humans; Hypersensitivity, Delayed; Immune Tolerance; Male; Practice Guidelines as Topic; Prognosis; Public Opinion; Skin Tests; Societies, Medical; Treatment Outcome
PubMed: 23745779
DOI: 10.1111/all.12161 -
Journal of Investigational Allergology... 2020
Topics: Adult; Biomarkers; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Delayed; Hypoglycemic Agents; Liraglutide; Skin Tests; Symptom Assessment
PubMed: 32301438
DOI: 10.18176/jiaci.0521 -
British Medical Bulletin Jan 1967
Review
Topics: Animals; Antibody Formation; Guinea Pigs; Hypersensitivity, Delayed; Macrophages; Mice
PubMed: 5342372
DOI: 10.1093/oxfordjournals.bmb.a070508 -
Contact Dermatitis Nov 1993Drug reactions are a common problem in hospital inpatients and outpatients. Oral or parenteral drug challenges are valuable diagnostic aids, but time consuming. We... (Review)
Review
Drug reactions are a common problem in hospital inpatients and outpatients. Oral or parenteral drug challenges are valuable diagnostic aids, but time consuming. We review attempts to diagnose delayed hypersensitivity drug eruptions by patch testing. We review control data, and offer an operational definition that might make for greater acceptance of the rôle of diagnostic patch testing in this entity.
Topics: Adolescent; Adult; Aged; Drug Eruptions; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Delayed; Male; Middle Aged; Patch Tests
PubMed: 8112060
DOI: 10.1111/j.1600-0536.1993.tb03555.x -
The AAPS Journal Dec 2005Cutaneous drug reactions (CDRs) are the most commonly reported adverse drug reactions. These reactions can range from mildly discomforting to life threatening. CDRs can... (Review)
Review
Cutaneous drug reactions (CDRs) are the most commonly reported adverse drug reactions. These reactions can range from mildly discomforting to life threatening. CDRs can arise either from immunological or nonimmunological mechanisms, though the preponderance of evidence suggests an important role for immunological responses. Some cutaneous eruptions appear shortly after drug intake, while others are not manifested until 7 to 10 days after initiation of therapy and are consistent with delayed-type hypersensitivity. This review discusses critical steps in the initiation of delayed-type hypersensitivity reactions in the skin, which include protein haptenation, dendritic cell activation/migration and T-cell propagation. Recently, an alternative mechanism of drug presentation has been postulated that does not require bioactivation of the parent drug or antigen processing to elicit a drug-specific T-cell response. This review also discusses the role of various immune-mediators, such as cytokines, nitric oxide, and reactive oxygen species, in the development of delayed-type drug hypersensitivity reactions in skin. As keratinocytes have been shown to play a crucial role in the initiation and propagation of cutaneous immune responses, we also discuss the means by which these cells may initiate or modulate CDRs.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity, Delayed; Skin; Skin Diseases
PubMed: 16594635
DOI: 10.1208/aapsj070480 -
Journal of Primary Care & Community... 2021The term "COVID arm" has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2...
The term "COVID arm" has been coined to describe a harmless delayed hypersensitivity reaction occurring approximately a week after administration of the novel SARS-CoV-2 mRNA vaccine. It appears as a red, warm, pruritic, indurated, or swollen area in the vicinity of the vaccine site. These reactions, especially if accompanied by systemic symptoms, have been mistaken for cellulitis. We report 3 cases of COVID arm, 2 of which were mistaken for cellulitis. Distinguishing features of COVID arm from cellulitis include pruritus as a common finding, occurrence approximately a week after vaccination, a lack of progression of symptoms, rapid response to topical steroids, and/or spontaneous resolution usually over 4 to 5 days.Practice Points:• Patients receiving SARS-CoV-2 vaccines may experience delayed hypersensitivity reactions characterized by erythema, swelling, and itching occurring near the vaccination site (COVID arm), approximately a week after vaccination.• Clinicians can distinguish SARS-CoV-2 vaccine reactions from cellulitis by the time of onset (approximately a week vs 5 days), by the lack of progression of symptoms, and resolution over 4 to 5 days.• Severe cases of COVID arm may be treated with topical steroids.
Topics: Arm; COVID-19; COVID-19 Vaccines; Cellulitis; Diagnostic Errors; Humans; Hypersensitivity, Delayed; SARS-CoV-2; Vaccines
PubMed: 34120504
DOI: 10.1177/21501327211024431 -
Current Pharmaceutical Design 2008Drug allergy refers to a hypersensitivity reaction for which either an IgE or T-cell-mediated mechanism is demonstrated. The recognition of the drug by B and T cells is... (Review)
Review
Drug allergy refers to a hypersensitivity reaction for which either an IgE or T-cell-mediated mechanism is demonstrated. The recognition of the drug by B and T cells is influenced by variants of HLA genes. The genetic factors involved in IgE-mediated mechanisms have been studied mainly in beta-lactam reactions, and they appear to be related to human leukocyte antigen presentation (HLA A2 and DRw52), TNFA -308G>A, class switching to IgE by B cells (variants of IL-13 and of IL-4RA), and expression of IgE receptors on target cells (variant of the FcepsilonRIbeta gene). Delayed T-cell-mediated reactions are also associated with HLA alleles. Studies have reported an association of HLA-B*1502 and HLA-B*5801 in patients with the Stevens-Johnson syndrome or toxic epidermal necrolysis provoked by carbamazepine, as well as of HLA-B*5701 with abacavir hypersensitivity. HLA-B*5701 seems to be a strong predictor in whites, but not in Hispanics or Africans. Carbamazepine hypersensitivity is also influenced by gene variants of cytochrome P450 enzymes on the generation of reactive metabolites, while CYP2C9*2 and CYP2C9*3 polymorphisms influence the bioactivation of sulfamethoxazole in prohapten. Pharmacogenetic studies on aspirin hypersensitivity have identified distinct types of predictors, such as HLA genotypes, a polymorphism in the promoter of the FcepsilonRIalpha gene, and variants in genes of enzymes from the arachidonic acid pathway. In the future, identification of genetic predictors will benefit from genomewide association studies that also take ethnic differences into account. Ideally, predictors will help to prevent adverse reactions, as suggested by a recent study on the effectiveness of prospective HLA-B*5701 screening to prevent hypersensitivity reactions to abacavir in HIV patients.
Topics: Animals; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Pharmacogenetics
PubMed: 18991696
DOI: 10.2174/138161208786369795 -
European Journal of Dermatology : EJD Apr 2017
Topics: Aged; Contrast Media; Cross Reactions; Delayed Diagnosis; Drug Hypersensitivity; Humans; Hypersensitivity, Delayed; Iohexol; Middle Aged; Patch Tests; Triiodobenzoic Acids
PubMed: 27965184
DOI: 10.1684/ejd.2016.2935 -
Allergy Jun 1996
Topics: Adult; Anti-Inflammatory Agents; Drug Hypersensitivity; Female; Humans; Hypersensitivity, Delayed; Pregnenediones; Skin Tests
PubMed: 8837672
DOI: 10.1111/j.1398-9995.1996.tb04646.x -
Contraception Jan 2015Nexplanon® is an etonogestrel implant with a long-acting contraceptive effect. Although several studies underlined its safety profile, its implant can rarely lead to...
Nexplanon® is an etonogestrel implant with a long-acting contraceptive effect. Although several studies underlined its safety profile, its implant can rarely lead to moderate or severe adverse event. Here, we presented a case of delayed-type hypersensitivity reaction against Nexplanon® that resolved after its removal.
Topics: Adult; Contraceptive Agents, Female; Desogestrel; Device Removal; Disease Progression; Drug Eruptions; Drug Hypersensitivity; Drug Implants; Equipment Failure; Female; Humans; Hypersensitivity, Delayed; Skin; Treatment Outcome
PubMed: 25284356
DOI: 10.1016/j.contraception.2014.08.014