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Current Opinion in Immunology Apr 1989
Review
Topics: Anaphylaxis; Anesthetics; Animals; Drug Hypersensitivity; Humans; Neuromuscular Blocking Agents; United Kingdom
PubMed: 2679717
DOI: 10.1016/0952-7915(89)90038-1 -
The Journal of Allergy and Clinical... Jan 2019The risk for developing immediate or delayed hypersensitivity reactions to radiocontrast media (RCM) interferes with the diagnosis and treatment of a number of patients... (Review)
Review
The risk for developing immediate or delayed hypersensitivity reactions to radiocontrast media (RCM) interferes with the diagnosis and treatment of a number of patients requiring imaging diagnostic methods for many common diseases. A group of experts met in Orlando, Florida, in March 2018 to analyze the similarities and differences in the management of RCM reactions in different areas of the world. This paper presents a summary of the recommendations provided by this consensus group, highlighting controversial issues and unmet needs that require further research.
Topics: Anaphylaxis; Basophil Degranulation Test; Consensus Development Conferences as Topic; Contrast Media; Diagnostic Imaging; Drug Hypersensitivity; Expert Testimony; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Skin Tests; United States
PubMed: 30573421
DOI: 10.1016/j.jaip.2018.06.030 -
CMAJ : Canadian Medical Association... Apr 2018
Review
Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Clinical Laboratory Techniques; Drug Eruptions; Drug Hypersensitivity; Humans; Medical History Taking; Skin Tests
PubMed: 29712672
DOI: 10.1503/cmaj.171315 -
Journal Der Deutschen Dermatologischen... Oct 2022
Topics: Drug Hypersensitivity; Floods; Humans
PubMed: 36252063
DOI: 10.1111/ddg.14939 -
Acta Medica Portuguesa Oct 2018Drug therapy is often a balance between the beneficial and harmful effects of drugs. Drug allergic reactions are adverse reactions mediated by immunological mechanisms... (Review)
Review
Drug therapy is often a balance between the beneficial and harmful effects of drugs. Drug allergic reactions are adverse reactions mediated by immunological mechanisms and usually not related to the pharmacological actions of the drug. They can be classified based either on the clinical presentation or the underlying immunological mechanism. Although uncommon, drug allergic reactions are unpredictable and can be very severe, even life threatening. The aim of this review was to provide clinicians from different medical specialties with a working tool to improve management of their patients with suspected drug allergy. It was conducted as a nonsystematic review, and attempts to describe the complexity of drug allergy. The information included ranges from pathophysiology to the heterogeneous clinical presentation, with a special focus on the drugs most frequently involved, as well as a classification of reactions and risk factors. Despite all advances in this challenging and complex field of allergy and clinical immunology, drug allergy is not yet fully established and understood. An exceptional contribution was brought by pharmacogenomics, even though a specific pharmacogenetic association has only been defined for a very limited number of drugs. Further studies are needed to obtain clearer answers when managing each individual case of drug allergy.
Topics: Drug Hypersensitivity; Humans; Immunogenetic Phenomena
PubMed: 30387427
DOI: 10.20344/amp.10092 -
Human Vaccines & Immunotherapeutics Oct 2012Allergic drug reactions occur when a drug, usually a low molecular weight molecule, has the ability to stimulate an immune response. This can be done in one of two ways.... (Review)
Review
Allergic drug reactions occur when a drug, usually a low molecular weight molecule, has the ability to stimulate an immune response. This can be done in one of two ways. The first is by binding covalently to a self-protein, to produce a haptenated molecule that can be processed and presented to the adaptive immune system to induce an immune response. Sometimes the drug itself cannot do this but a reactive breakdown product of the drug is able to bind covalently to the requisite self-protein or peptide. The second way in which drugs can stimulate an immune response is by binding non-covalently to antigen presenting or antigen recognition molecules such as the major histocompatibility complex (MHC) or the T cell receptor. This is known as the p-I or pharmacological interaction hypothesis. The drug binding in this situation is reversible and stimulation of the response may occur on first exposure, not requiring previous sensitization. There is probably a dependence on the presence of certain MHC alleles and T cell receptor structures for this type of reaction to occur.
Topics: Antigen Presentation; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Receptors, Antigen, T-Cell
PubMed: 22922763
DOI: 10.4161/hv.21889 -
The Journal of Allergy and Clinical... Aug 2021Drug hypersensitivity reactions (DHR) are heterogeneous in their pathomechanisms, clinical presentation, severity, and outcomes. Novel DHR mechanisms, phenotypes, and... (Review)
Review
Drug hypersensitivity reactions (DHR) are heterogeneous in their pathomechanisms, clinical presentation, severity, and outcomes. Novel DHR mechanisms, phenotypes, and endotypes have been described. The key to prevention from further exposure to the culprit drugs involves correct identification of the putative drug through a combination of in vitro and/or in vivo tests, accurate drug allergy labeling and reporting, and electronic decision support systems within electronic medical records to prevent future accidental prescribing. Prescreening and premedication, the focus of this review, may be a useful adjunct to preventive measures in certain situations. After an index immediate drug hypersensitivity reaction, prescreening may be useful in perioperative anaphylaxis, and iodinated (ICM) and gadolinium-based contrast media (GCM) where the culprit and potential alternative agents are skin tested. In certain nonimmediate DHR, pharmacogenomic prescreening may be used before prescribing high-risk drugs (eg, carbamazepine and allopurinol) where specific human-leukocyte antigen genotypes are associated with severe cutaneous adverse reactions. Premedication with antihistamine and systemic corticosteroids is another therapeutic strategy to prevent infusion reactions for certain biologicals and chemotherapeutic agents, in cases of perioperative anaphylaxis, ICM and GCM DHR, and clonal mast cell disorders. Rapid drug desensitization may also be used to induce temporary tolerance in situations where there are limited alternative drugs.
Topics: Allopurinol; Contrast Media; Drug Hypersensitivity; Humans; Premedication; Skin Tests; Stevens-Johnson Syndrome
PubMed: 34366094
DOI: 10.1016/j.jaip.2021.04.006 -
Annals of Allergy, Asthma & Immunology... Dec 2022Studies including diagnostic workups on true drug allergy in children are limited.
BACKGROUND
Studies including diagnostic workups on true drug allergy in children are limited.
OBJECTIVE
To evaluate the frequency of confirmed drug allergy in children with a history of suspected drug allergy who had applied to the general pediatric outpatient clinics of our hospital owing to various health problems.
METHODS
The history of drug allergy was asked among children who applied to the general pediatric outpatient clinics of our hospital. Allergy tests were performed to confirm drug allergy in children whose history was compatible with drug allergy.
RESULTS
In this study, parents of 5553 children aged between 4 months and 17.9 years were asked, "Has your child ever developed an allergy after drug use?" A total of 7% of the parents (n = 389/5553) thought that their child had a drug allergy. When these patients were evaluated by a pediatric allergist, it was suspected that 21.1% (n = 82/389) had a drug allergy. When diagnostic tests were performed for drug allergy, drug allergy was confirmed in only 4.2% (n = 3/72). Consequently, the frequency of drug allergy according to the history was 1.47% (n = 82/5553) in the population we studied, whereas the frequency of confirmed drug allergy was found to be 0.05% (n = 3/5553).
CONCLUSION
The patient or parent statements alone are not sufficient for the diagnosis of drug allergy in children. To confirm or rule out drug allergy, drug allergy tests must be performed so unnecessary drug restrictions can be avoided.
Topics: Child; Humans; Infant; Skin Tests; Drug Hypersensitivity; Parents; Ambulatory Care Facilities
PubMed: 36126914
DOI: 10.1016/j.anai.2022.09.017 -
International Archives of Allergy and... 2022Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming....
INTRODUCTION
Although drug allergy workup for pediatric patients (skin and drug provocation tests [DPT]) is performed, the procedures are troublesome, painful, and time-consuming. The aim of this study was to assess parents' perception of and satisfaction with their child's drug allergy workup. Further, to evaluate parents' tendency to use the tested drug following a negative DPT and the consequences of re-exposure.
METHODS
Parents of children that underwent drug allergy workup from January 2017 to August 2020 in the Pediatric Allergy Department of Trakya University Medical Faculty were included. Satisfaction levels were assessed via a telephone questionnaire (3 open-ended, 7 multiple-choice questions). Satisfaction was scored on a Likert scale (1: very unsatisfied and 5: very satisfied).
RESULTS
A total of 102 parents participated the study. Fifty-two (51%) of patients were male, and median age was 6.2 years and a median time interval between admission and test appointment of 1 month; 16.7% had a positive drug allergy workup, with 88.3% reporting being satisfied (56.9%) or very satisfied (31.4%) with the workup. Satisfaction levels were inversely related to the time between admission and test appointment (rho: -0.254, p = 0.01), with 8.2% reporting they did not use the tested drug when necessary despite a negative result. The tested drug was used by 35 individuals (41.1%), 33 (94.2%) tolerating without reaction.
CONCLUSION
Most parents were satisfied with the workup, but levels were inversely related to the admission and procedure time interval. Drug allergy workup should be performed as soon as possible to relieve parents' anxiety and achieve more patient satisfaction.
Topics: Adolescent; Age Factors; Child; Child, Preschool; Disease Management; Drug Hypersensitivity; Female; Health Care Surveys; Humans; Infant; Male; Parents; Patient Satisfaction; Personal Satisfaction; Practice Patterns, Physicians'; Surveys and Questionnaires
PubMed: 34518470
DOI: 10.1159/000518583 -
Clinical Reviews in Allergy May 1986
Review
Topics: Anaphylaxis; Anemia; Boston; Desensitization, Immunologic; Drug Hypersensitivity; Fever; Humans; Liver; Lymphoma; Penicillins; Phenytoin; Premedication; Respiratory System; Skin; Skin Tests; Thrombocytopenia; Vasculitis, Leukocytoclastic, Cutaneous
PubMed: 3516358
DOI: 10.1007/BF02991106