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Clinical and Experimental Allergy :... Aug 2020Alpha-gal syndrome (AGS) describes a wide spectrum of hypersensitivity reactions mediated by specific IgE to the α-gal epitope (galactose-α-1,3-galactose) ubiquitously... (Review)
Review
Alpha-gal syndrome (AGS) describes a wide spectrum of hypersensitivity reactions mediated by specific IgE to the α-gal epitope (galactose-α-1,3-galactose) ubiquitously expressed on glycolipids/glycoproteins of most mammals. This fascinating new entity has completely changed the paradigms of allergy as allergic response is directed against an oligosaccharide and the reactions can be both immediate and delayed. They appear to be stimulated only by tick bites which induce production of α-gal specific IgE antibodies that lead to (at times fatal) hypersensitivity response. AGS is completely different to previously described anaphylaxis to tick saliva. It provides unique insight into the interplay between different arms of the immune system and the role of ectoparasites in the development of anaphylaxis to food and medication in patients at risk of tick bites including travellers. This review summarises recent advances in our understanding of its clinical presentation, pathomechanism and role of various tick species in the development of AGS.
Topics: Allergens; Anaphylaxis; Animals; Desensitization, Immunologic; Disaccharides; Drug Hypersensitivity; Epitopes; Food Hypersensitivity; Humans; Immunoglobulin E; Insect Proteins; Prognosis; Risk Factors; Saliva; Tick Bites
PubMed: 32542789
DOI: 10.1111/cea.13683 -
Allergy May 2018Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public... (Review)
Review
Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public health problem. However, knowledge in DHRs morbidity and mortality epidemiological data is still not optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the WHO International Classification of Diseases (ICD) system to classify diagnoses, health services utilization, and death data. The misclassification of disorders in the ICD system contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation. It also hampers clinical practice and prevention actions. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD-11 revision agenda, we report the advances and use of the pioneering "Drug hypersensitivity" subsection of ICD-11 and implementation in the WHO International Classification of Health Interventions (ICHI). The new classification addressed to DHRs will enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies and better facilitate healthcare planning and decision-making and public health measures to prevent and reduce the morbidity and mortality attributable to DHRs.
Topics: Drug Hypersensitivity; Humans; International Classification of Diseases; World Health Organization
PubMed: 29105793
DOI: 10.1111/all.13335 -
The Journal of Allergy and Clinical... Aug 2021The current method of defining, reporting, assessment, labeling, delabeling, and reconciliation of adverse drug reactions (ADRs), and specifically immunologically...
The current method of defining, reporting, assessment, labeling, delabeling, and reconciliation of adverse drug reactions (ADRs), and specifically immunologically mediated drug hypersensitivity reactions (HSRs), in electronic health records (EHRs) is inadequate and compromises care quality and safety. It is critical to accurately and succinctly report the signs and symptoms associated with ADRs and suspected HSRs to enable clinicians to determine the plausible reaction type and help guide appropriate future management plans. Despite the current limitations of the EHR allergy module, we must encourage improved clinical documentation and demand technological improvements. Telehealth methods have been shown to be valuable in the assessment of ADRs and HSRs, particularly in the case of penicillin allergy evaluation and delabeling. The implementation, assessment, and refinement of advanced technologies, including clinical informatics and artificial intelligence, along with continued education of health care providers have potential to improve EHR documentation and communication, thereby advancing patient safety efforts.
Topics: Artificial Intelligence; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Electronic Health Records; Humans; Penicillins
PubMed: 33607342
DOI: 10.1016/j.jaip.2021.02.005 -
Allergy and Asthma Proceedings 2012Drug allergy describes clinical adverse reactions that are proved or presumed to be immunologically based. Allergic drug reactions do not resemble pharmacologic actions... (Review)
Review
Drug allergy describes clinical adverse reactions that are proved or presumed to be immunologically based. Allergic drug reactions do not resemble pharmacologic actions of the incriminated drug and may occur at fractions of what would be the therapeutic dosage. Allergic drug reactions are unpredictable; nevertheless, there is increased risk of drug hypersensitivity in (1) patients with cystic fibrosis who receive antibiotics; (2) patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who receive trimethoprim/sulfamethoxazole of if HLA-B*5701(+) and receive the antiretroviral agent, abacavir; (3) other genetically susceptible populations such as Han-Chinese who are HLA-B*1502(+) who develop Stevens-Johnson syndrome and toxic epidermal necrolysis from carbamazepine or if HLA-B*5801(+) are at increased risk for such reactions from allopurinol; and (4) patients with a history of previous compatible allergic reaction to the same medication, similar class, or potentially unrelated medication. Specific patient groups at higher risk for drug allergy include those with Ebstein-Barr virus infection, chronic lymphatic leukemia, HIV/AIDS, cystic fibrosis, patients with seizures being treated with antiepileptic medications, and patients with asthma (especially severe asthma) who are at increased risk of anaphylaxis from any cause including drugs compared with patients without asthma. In patients with a history of penicillin allergy, skin testing helps clarify the current level of risk for anaphylaxis by using the major (penicilloyl-polylysine) and minor penicillin determinants where sensitivity is 99%. If penicilloyl-polylysine and penicillin G are used for skin testing, the sensitivity is ∼85%. When skin tests are negative, graded challenges are performed to administer optimal or truly essential antibiotics.
Topics: Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans
PubMed: 22794703
DOI: 10.2500/aap.2012.33.3563 -
The Journal of Allergy and Clinical... Oct 2020
Topics: Drug Hypersensitivity; Humans; Penicillins; Precision Medicine; Public Health; Quality Improvement
PubMed: 32781047
DOI: 10.1016/j.jaip.2020.07.046 -
Boletin Medico Del Hospital Infantil de... Jul 1993Adverse reaction to drugs are classified as immunological and non-immunological. It is consider that one to five percent of the general population reactions to drugs.... (Review)
Review
Adverse reaction to drugs are classified as immunological and non-immunological. It is consider that one to five percent of the general population reactions to drugs. Allergic reactions are the most intense and dangerous, but they represent only five to ten per cent of all of them. Immunological adverse reactions may be induced by the drug or by their metabolites. There are risk factors to induced allergic reactions such as doses, administration time and way of administration. The four mechanism of damage from Gell and Coombs are discussed regarding to drugs, stressing the penicillin issue. Other common drugs reactions in the diary practice are cutaneous reactions with unknown immunological mechanism as it happens in febrile mucocutaneous syndrome and the phototoxic and photoallergic reactions. Pseudoallergic or "anaphylactoid" reactions have signs and symptoms like those of anaphylaxis, but the mechanism of damage is not immunological, as with local and general anesthetics and radiopaque media. Treatment for any adverse events is to stop the administration as soon as possible. The drug of choice is 1:1000 subcutaneous adrenaline besides colloid solutions, steroids and antihistaminics.
Topics: Anaphylaxis; Child; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans
PubMed: 8363752
DOI: No ID Found -
Current Opinion in Allergy and Clinical... Aug 2010The review intends to clarify understanding of when and how skin patch tests can be used to help drug allergy diagnosis and identify causally relevant drugs. It aims to... (Review)
Review
PURPOSE OF REVIEW
The review intends to clarify understanding of when and how skin patch tests can be used to help drug allergy diagnosis and identify causally relevant drugs. It aims to give an understanding of which clinical patterns of drug reaction are produced by T-lymphocyte-mediated pathomechanisms since these are what are detected by patch tests. It also covers fundamental principles underlying patch test methodology and summarizes clinical patterns and causal drugs for which patch tests have reasonable value to diagnose culprit drugs.
RECENT FINDINGS
A number of recent studies have consolidated evidence that the use of patch tests in drug hypersensitivity diagnosis is not a robust science. The field is bedeviled by the lack of standardized approach to ascertain and define clinical entities in a sufficiently clear way that allows researchers to be confident that patch tests are used appropriately in T-cell-mediated clinical conditions. The literature is confounded by case series including patch tests from conditions which may be the wrong type of test causing the sensitivity of the test system to be measured incorrectly.
SUMMARY
For certain drug eruptions mediated by T cells (exanthemata, acute generalized exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms, erythema multiforme/toxic epidermal necrolysis, fixed drug eruption and symmetrical drug-related intertriginous and flexural exanthem) patch tests can elicit positive responses in a proportion of cases. The test works best with aromatic anticonvulsants and various antibiotics but does not appear to work consistently with a wide range of drugs. A coordinated and systematic research effort is required to resolve inconsistencies to encourage greater utilization of this potentially important diagnostic methodology.
Topics: Diagnostic Uses of Chemicals; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Patch Tests; Pharmaceutical Preparations; T-Lymphocytes
PubMed: 20485160
DOI: 10.1097/ACI.0b013e32833aa54d -
Iranian Journal of Allergy, Asthma, and... Oct 2020Sometimes allergic reactions caused by various food allergens often hidden in the composition of medications can mistakenly be diagnosed as drug allergies. Such...
Sometimes allergic reactions caused by various food allergens often hidden in the composition of medications can mistakenly be diagnosed as drug allergies. Such reactions can especially be unexpected if antihistamines-virtually designed to treat allergy symptoms, are imitated. We present the case of a 37-year-old female patient with cutaneous allergic reaction initially diagnosed as drug allergy to desloratadine/aerius, a desloratadine-containing antihistamine medication. The diagnostic search began with the anamnestic data of the patient about an allergy to cooked corn in her childhood, current seasonal allergic rhinitis, and hand dermatitis probably related to her professional activity. Skin tests and additional laboratory examinations led to diagnosing corn/maize allergy manifested as both food (mainly) and pollen allergy. Besides, it was concluded that hand dermatitis also can becaused by cornstarch contained in medical gloves. Finally, based on the results of a drug challenge test performed with two desloratadine-containing medications-desloratadine/aerius containing cornstarch as an excipient and desloratadine/lordestinenot containing cornstarch, the causative significance of corn was confirmed. Thus, the initial diagnosis of drug allergy was changed to that of food allergy.
Topics: Adult; Allergens; Drug Hypersensitivity; Female; Food Hypersensitivity; Humans; Rhinitis, Allergic, Seasonal
PubMed: 33463123
DOI: 10.18502/ijaai.v19i5.4472 -
Revista Alergia Mexico (Tecamachalco,... 2022Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams....
Betalactams are the most widely used antimicrobials for their safety and efficacy. These include the penicillins, cephalosporins, carbapenems, and monobactams. Penicillin allergy ranks first in relation to drug allergy. 10 to 20 % of the population is labeled as allergic to it, often wrongly. Cross reaction is reported in 2 to 5 % between penicillins and cephalosporin. There is no cross reaction between penicillins and aztreonam, but there is with ceftazidime. All the mechanisms of the Gell and Coombs classification are included in the pathophysiology of hypersensitivity reactions to penicillin. Stratification according to risk allows us to take the most objective behavior to label the patient as allergic to. In the natural history of penicillin allergy, 80-90 % of patients lose this sensitivity by 10 years. If necessary, the patient can undergo a desensitization protocol. The immuno-allergist is a key piece in the selection of the patient, the elaboration of the challenge and desensitization protocols, in a controlled environment.
Topics: Anti-Bacterial Agents; Carbapenems; Cephalosporins; Cross Reactions; Drug Hypersensitivity; Humans; Penicillins; Skin Tests
PubMed: 34998313
DOI: 10.29262/ram.v69iSup1.1038 -
Journal of Immunological Methods Aug 2021This article aims to envisage future perspectives of the lymphocyte transformation test (LTT). We describe the select innovative techniques, which can be integrated at... (Review)
Review
This article aims to envisage future perspectives of the lymphocyte transformation test (LTT). We describe the select innovative techniques, which can be integrated at different stages of the LTT to potentially improve the sensitivity, specificity, or practicability of the LTT. We first focus upon the cell sorting techniques comprising immunomagnetic cell separation and flow cytometry, which can be implemented prior and after the LTT culturing step to concentrate and quantify specific immune cell types. Further, we elaborate upon three important omics techniques such as transcriptomics, proteomics, and metabolomics, which can be integrated downstream of the LTT to analyze molecular changes in specific immune cells following drug induced activation and proliferation. We also develop visions, how state of the art techniques used in other scientific fields, can be transferred and applied in the context of in-vitro detection of drug allergy.
Topics: Biomarkers; Cells, Cultured; Drug Hypersensitivity; Flow Cytometry; Gene Expression Profiling; Genomics; Humans; Immunologic Tests; Immunomagnetic Separation; Lymphocyte Activation; Lymphocytes; Metabolomics; Predictive Value of Tests; Proteomics; Reproducibility of Results
PubMed: 34000289
DOI: 10.1016/j.jim.2021.113072