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The Medical Journal of Australia Jun 2022
Topics: Anaphylaxis; Australia; Drug Hypersensitivity; Food Hypersensitivity; Humans; Registries
PubMed: 35568381
DOI: 10.5694/mja2.51527 -
Current Opinion in Pediatrics Jun 2023To review updated recommendations in the 2022 Drug Allergy Practice Parameters for the evaluation and management of drug hypersensitivity reactions. (Review)
Review
PURPOSE OF REVIEW
To review updated recommendations in the 2022 Drug Allergy Practice Parameters for the evaluation and management of drug hypersensitivity reactions.
RECENT FINDINGS
Adverse drug reactions have become increasingly prominent with the advent of new and emerging pharmacologic therapies. Hypersensitivity reactions encompass a significant proportion of adverse drug reactions and negatively impact both the individual patient and overall health system. Reactions are heterogeneous in presentation and may be immediate (onset of symptoms ≤6 h) or delayed (onset of symptoms >6 h to months) after drug exposure. The 2022 Drug Allergy Practice Parameter provides consensus-based statements for evaluation of hypersensitivity reactions to antibiotics, NSAIDs, cancer chemotherapies, immune checkpoint inhibitors, biologics, and excipients. In general, the guideline highlights the importance of patient history in elucidating the phenotype and severity of the index reaction. Drug challenge remains the gold standard for diagnosis and is increasingly favored over skin testing in patients with nonsevere, nonanaphylactic drug reaction histories.
SUMMARY
The 2022 Drug Allergy Practice Parameter provides an updated framework for physicians to reference in clinical practice when managing patients with drug hypersensitivity reactions.
Topics: Humans; Drug Hypersensitivity; Anti-Bacterial Agents; Skin Tests; Anti-Inflammatory Agents, Non-Steroidal
PubMed: 36927991
DOI: 10.1097/MOP.0000000000001240 -
Therapeutische Umschau. Revue... Jan 1994Drug allergies can cause a great variety of symptoms and can thus imitate various diseases, like in previous times the lues. Drug allergies can be classified into three... (Review)
Review
Drug allergies can cause a great variety of symptoms and can thus imitate various diseases, like in previous times the lues. Drug allergies can be classified into three subgroups, which differ in their pathophysiology and require different diagnostic steps: firstly, classical drug allergies which are directed to the drug itself, a reactive compound of it or some contamination of the drug; secondly, pseudoallergic reactions which are caused by nonimmune mediated degranulation of mast cells and basophils; and thirdly, autoimmune reactions in which the drug elicits an immune reaction to autologous structures. A very detailed (criminalistic) history has the highest priority for the clarification of a suspected drug-allergic reaction; in addition, skin tests, serological tests and the lymphocyte transformation test might be useful. One should differentiate between tests which imitate the drug-elicited allergic reaction (i.e. Coombs test in drug induced hemolytic anemia) and tests which solely indicate a sensitization, these tests should be interpreted accordingly.
Topics: Drug Eruptions; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Intradermal Tests; Lymphocyte Activation; Patch Tests; Risk Factors
PubMed: 8146813
DOI: No ID Found -
Clinical Reviews in Allergy & Immunology Jun 2022Perioperative anaphylaxis (PA) is a rare but life-threatening condition that poses diagnostic and management challenges in the operating room. The incidence of severe... (Review)
Review
Perioperative anaphylaxis (PA) is a rare but life-threatening condition that poses diagnostic and management challenges in the operating room. The incidence of severe perioperative reactions is estimated to be approximately 1:7000-10,000. Management involves both immediate stabilization of the patient and identifying the culprit agent. Identification is essential to prevent recurrence of the event in subsequent surgeries and to avoid unnecessary labeling of drug allergy. Identifying all possible exposures including medications, disinfectants, latex, and dyes and choosing the appropriate tests are essential for proper evaluation. To identify the culprit, primary testing modalities include tryptase at the time of the reaction with subsequent levels and skin testing with nonirritating concentrations to the medications and substances utilized during the procedure and those potentially used as alternates. This strategy provides guidance for future surgeries and procedures. Close collaboration between the allergy, anesthesiology, and surgery teams is essential for appropriate management of these patients at the time of the reaction, during the post event evaluation and in preparation for subsequent surgeries.
Topics: Anaphylaxis; Drug Hypersensitivity; Humans; Skin Tests; Tryptases
PubMed: 34247332
DOI: 10.1007/s12016-021-08874-1 -
Allergy Feb 2022Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and...
Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.
Topics: Anaphylaxis; Antineoplastic Agents; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Neoplasms; Skin Tests
PubMed: 34587281
DOI: 10.1111/all.15113 -
JAMA Aug 1992
Topics: Aged; Ampicillin; Angioedema; Drug Hypersensitivity; Enalapril; Female; Humans; Nitrofurantoin
PubMed: 1640578
DOI: No ID Found -
Toxicology Feb 2001Due to the potential hazards of drug allergies, an early and reliable diagnosis is crucial. The use of in vivo tests is not recent but, because of the hazards of skin... (Review)
Review
Due to the potential hazards of drug allergies, an early and reliable diagnosis is crucial. The use of in vivo tests is not recent but, because of the hazards of skin testing in patients with a history of anaphylaxis, they had been abandoned for a while. Recent reevaluations have shown that for some drugs, e.g. antibiotics-reliable skin tests can ensure the diagnosis of drug allergy in up to 70% of cases. Many in vitro tests based on well-defined mechanisms, e.g. the basophil degranulation test have been used for the diagnosis of totally unrelated allergic mechanisms. It is almost impossible to interpret their validity as diagnosis tools. Nevertheless, other tests, e.g. the lymphocyte transformation test which have been evaluated in well-conducted recent studies, seem to have a good predictive value. Their use is still restricted to clinical trials or research studies. A reliable clinical approach as well as a detailed examination of the drug intake remains obligatory to diagnose drug allergy. Available in vivo and in vitro tests are sometimes used to confirm the diagnosis. The sensitivity and specificity of these tests is evaluated in clinical studies. Research to improve the existing tests and to develop new diagnostic tools is still of paramount importance.
Topics: Animals; Cells, Cultured; Disease Models, Animal; Drug Hypersensitivity; Humans; Immunologic Tests; Lymphocyte Activation; Predictive Value of Tests
PubMed: 11164987
DOI: 10.1016/s0300-483x(00)00396-6 -
Immunology and Allergy Clinics of North... May 2022This review focuses on the current applications of telemedicine for drug hypersensitivity reactions. Telemedicine holds promise as a tool to risk-stratify patients with... (Review)
Review
This review focuses on the current applications of telemedicine for drug hypersensitivity reactions. Telemedicine holds promise as a tool to risk-stratify patients with drug hypersensitivity, for both evaluation of penicillin allergies and severe cutaneous adverse reactions. Although telemedicine may not fully replace in-person assessment owing to the need for testing, challenges, and in-person physical examination or skin biopsy, it may allow for risk stratification whereby some in-person visits may not be necessary. Electronic consults have also emerged along with telemedicine as a tool for drug allergy evaluations.
Topics: Drug Hypersensitivity; Humans; Physical Examination; Telemedicine
PubMed: 35469621
DOI: 10.1016/j.iac.2021.12.007 -
Current Opinion in Allergy and Clinical... Oct 2010In the last years, many novel drugs have been introduced, generating new patterns of drug hypersensitivity. There are also novel clinical and biologic techniques that... (Review)
Review
PURPOSE OF REVIEW
In the last years, many novel drugs have been introduced, generating new patterns of drug hypersensitivity. There are also novel clinical and biologic techniques that have enabled us to understand the mechanisms and diagnosis of reactions to old used drugs. This review summarizes current knowledge on the epidemiology, mechanisms, and clinical and in-vitro diagnosis of these reactions.
RECENT FINDINGS
Traditional and complementary alternate medicines are also causes of adverse drug reactions, and many of them are cataloged as allergy. Research in the field of skin and drug provocation test to antibiotics such as beta-lactams and carbapenems, and iodinated and gadolinium contrast media has allowed the understanding of cross-reactivity reactions and permitted the use of well tolerated alternate drugs in cases of proper negative drug allergy work-up. Many unique cases have been reported, including diverse drugs as infliximab, succinylcholine, hydroxychloroquine, that widen the spectrum of clinical manifestations of drug hypersensitivity to various drugs. Several studies have been published in the field of in-vitro diagnosis, including basophil activation tests, radioallergosorbent test, Immuno-Cap, ELISA, enzyme-linked immunospot assays, and T-cell proliferation tests allowing novel approaches to assess drug allergy.
SUMMARY
As new and old drugs continue to be used, new reports regarding new and known drug hypersensitivity manifestations are made. Advances in mechanisms are enhanced by the use of new in-vitro techniques to detect specific antibodies or T cells. Research in the field of skin and provocation tests has allowed the use of well tolerated alternate drugs in individuals with proven drug allergy.
Topics: Anesthetics; Anti-Bacterial Agents; Antibodies; Contrast Media; Cross Reactions; Drug Hypersensitivity; Drugs, Investigational; Humans; Immunologic Tests; T-Lymphocytes
PubMed: 20706115
DOI: 10.1097/ACI.0b013e32833e0896 -
Current Opinion in Allergy and Clinical... Aug 2001Adverse drug reactions occur in 10-20% of hospitalized patients, and up to one-third of these are of an allergic or pseudo-allergic nature. Allergic reactions are... (Review)
Review
Adverse drug reactions occur in 10-20% of hospitalized patients, and up to one-third of these are of an allergic or pseudo-allergic nature. Allergic reactions are unpredictable adverse effects that are linked to immunological mechanisms. Pseudo-allergic reactions are unpredictable adverse reactions that are clinically similar to allergic reactions, but for which there are no drug-specific antibodies or T lymphocytes. There is a paucity of tools that allow a definite diagnosis, and most of the available ones still require validation. Therefore, there are few true epidemiological data, and most of those that are available, including incidence, mortality and socioeconomic impact data, should be interpreted with caution.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Incidence; Prevalence; Socioeconomic Factors
PubMed: 11964705
DOI: 10.1097/01.all.0000011031.16814.e0