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Turkish Journal of Medical Sciences Oct 2021Coronavirus Disease 2019 (COVID-19) affected the whole world in a short time. One of the most influential public health initiatives modern medicine has to offer, the... (Review)
Review
Coronavirus Disease 2019 (COVID-19) affected the whole world in a short time. One of the most influential public health initiatives modern medicine has to offer, the vaccine has become even more important as the COVID-19 pandemic continues to worsen worldwide. Many vaccine trials were launched during the COVID-19 pandemic, and these vaccines were widely used around the world, offering realistic hope for ending the pandemic. Allergic reactions to vaccines were reported shortly after their approval. These reactions, in general, are rare, but, in some circumstances, they can be serious. Allergy to vaccines can occur because of either the active vaccine component or vaccine ingredients. The spectrum of the reactions may be just a local hypersensitiviy reaction or may be as severe as an anaphylaxis, which is an acute severe, life-threatening systemic hypersensitive reaction, and it requires quick intervention. If an allergy is suspected, a correct examination followed by algorithms is important for true diagnosis, treatment, and decision regarding revaccination. Patients who experience an allergic reaction with the first dose of covid 19 vaccine should be directed to the allergy-immunologist, and the evaluation of at-risk patients should be individualized. Finally, we should point out that the benefits of current COVID-19 vaccines go far beyond the side effects, and that the vaccine is the most important way to recover from the pandemic.
Topics: Algorithms; COVID-19 Vaccines; Drug Hypersensitivity; Humans
PubMed: 34333906
DOI: 10.3906/sag-2104-329 -
Journal of Immunological Methods Jun 2021Drug-induced hypersensitivity reactions encompass a variety of different clinical phenotypes ranging from harmless rashes to fatal reactions. They can be classified into... (Review)
Review
Drug-induced hypersensitivity reactions encompass a variety of different clinical phenotypes ranging from harmless rashes to fatal reactions. They can be classified into allergic (i.e. drug allergy) and non-allergic reactions (i.e. non-allergic hypersensitivity). Drug allergies in turn can either be antibody (e.g. IgE) or T cell-mediated. One of the diagnostic tools for the in vitro detection of drug allergy is the lymphocyte transformation test (LTT) which is based on the activation and expansion of the drug-specific memory T cells following co-incubation of the patient's peripheral mononuclear cells (PMBC) with the suspected drug in vitro. The read-out parameter in the classical LTT is T cell proliferation which can be measured as counts per minute following the addition of radiolabeled thymidine to the cell culture. However, in the course of time different modifications of the classical LTT with regard to the read-out parameters and methods have been proposed. Likewise, variations of the LTT platform itself have been described in the literature. This review article describes the development of the classical LTT and its use in the context of drug allergy detection and summarizes the modifications which have been published over time.
Topics: Drug Hypersensitivity; Humans; Immunologic Tests; Lymphocyte Activation; Lymphocytes
PubMed: 33745950
DOI: 10.1016/j.jim.2021.113036 -
Acta Bio-medica : Atenei Parmensis Jan 2019Drug allergy is an increasing problem worldwide, affecting all populations and races, children and adults, and for which diagnosis and treatment are not well... (Review)
Review
Drug allergy is an increasing problem worldwide, affecting all populations and races, children and adults, and for which diagnosis and treatment are not well standardized yet. Besides classical treatments, new drugs have been developed, especially for patients suffering from malignancies and chronic inflammatory diseases, that specifically target the cause of the disease. For those patients requiring such molecules, it is sometimes difficult to find an alternative drug when hypersensitivity reactions occur. Desensitization is therefore the best option whenever no alternative therapy is available but also when alternative treatments are considered therapeutically inferior and or more toxic. Despite its clinical success, little is known about the mechanisms and molecular targets of drug desensitization. Desensitization protocols use a gradual dose escalation to allow the safe administration of a treatment to which a patient previously presented a hypersensitivity reaction. The procedure requires special training and coordination of an allergy team, including physicians, nurses, and pharmacists, working together to safely and successfully implement desensitization protocols when appropriate. There is no difference in desensitization protocol between adults and children, except for the final cumulative dose of the administered drug.
Topics: Anti-Bacterial Agents; Child; Desensitization, Immunologic; Drug Hypersensitivity; Humans
PubMed: 30830058
DOI: 10.23750/abm.v90i3-S.8158 -
International Archives of Allergy and... 2019Within the broad category of adverse drug reactions in children, there has been a recent focus specifically on the evaluation of children with antibiotic allergy, in... (Review)
Review
Within the broad category of adverse drug reactions in children, there has been a recent focus specifically on the evaluation of children with antibiotic allergy, in particular, beta-lactam allergy. The potential consequences of being labeled beta-lactam allergy are increasingly recognized. Appropriate evaluation of children with suspected reactions to antibiotics is essential as it is increasingly being recognized that the label of "penicillin allergy" is associated with adverse health and economic outcomes. This review will focus on the 3 main classes of antibiotics reported to cause allergic reactions in children: beta lactams (penicillin derivatives and cephalosporins), macrolides, and sulfonamides. This article is a narrative review of the prevalence, diagnosis, and management of different types of antibiotic allergies in children. Our review reveals that antibiotic allergy is often overreported and not appropriately diagnosed in the pediatric age groups. There is a recent shift in the diagnostic paradigm from the use of skin tests and if negative challenges to the use of challenge only in the pediatric age group. Larger studies to establish the usefulness and safety of this new approach as well as updated guidelines are needed.
Topics: Anaphylaxis; Child; Drug Hypersensitivity; Humans; Infant; Macrolides; Skin Tests; Sulfonamides; beta-Lactams
PubMed: 31394524
DOI: 10.1159/000501518 -
Journal of Investigational Allergology... Apr 2018
Topics: Anaphylaxis; Basophil Degranulation Test; Basophils; Drug Hypersensitivity; Etoricoxib; Female; Humans; Middle Aged
PubMed: 29661743
DOI: 10.18176/jiaci.0221 -
Current Allergy and Asthma Reports Feb 2021The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring... (Review)
Review
PURPOSE OF REVIEW
The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19.
RECENT FINDINGS
There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.
Topics: Asthma; Biological Products; COVID-19; Dermatitis, Allergic Contact; Dermatitis, Atopic; Desensitization, Immunologic; Disease Management; Disease Outbreaks; Drug Hypersensitivity; Food Hypersensitivity; Health Personnel; Humans; Infection Control; Pandemics; Personal Protective Equipment; Physical Distancing; Rhinitis, Allergic; SARS-CoV-2; Telemedicine
PubMed: 33560451
DOI: 10.1007/s11882-021-00989-x -
British Journal of Clinical Pharmacology May 2011Adverse reactions to medication are common. Some are predictable side-effects of the drug, others involve individual sensitivity to the drug. Allergic reactions are an... (Review)
Review
Adverse reactions to medication are common. Some are predictable side-effects of the drug, others involve individual sensitivity to the drug. Allergic reactions are an important subset of these, but other specific sensitivities are caused by variations in the metabolism or mode of action of the drug. Patients who have experienced adverse reactions to medication will often refer to themselves as being allergic to the drug, regardless of the actual mechanism that caused the reaction. Consequently, anyone taking a history of 'drug allergy' needs to keep an open mind about the mechanism that may have been involved. Fortunately, most idiosyncratic reactions are minor, but some are severe, or even life-threatening. In most situations, there are satisfactory alternatives for the drug in question, but sometimes it is necessary to investigate and get an accurate diagnosis. The over-riding priority is to distinguish anaphylactic, potentially life-threatening reactions from other types of drug reaction, which are generally more protracted, less dangerous and usually managed by simple avoidance. While all doctors need to understand the underlying principles, drug challenges should only be undertaken by clinicians experienced in this area.
Topics: Drug Eruptions; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Humans; Immune Tolerance
PubMed: 21306416
DOI: 10.1111/j.1365-2125.2011.03933.x -
Allergy Dec 2019Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and... (Review)
Review
Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management. Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication. Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs.
Topics: Cost of Illness; Disease Management; Disease Susceptibility; Drug Hypersensitivity; Drug Labeling; Humans; Incidence; Risk Assessment; Risk Factors
PubMed: 31557314
DOI: 10.1111/all.14061 -
Medicina (Kaunas, Lithuania) May 2020Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic... (Review)
Review
Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.
Topics: Adolescent; Antibodies, Monoclonal; Biological Products; Child; Cytokine Release Syndrome; Drug Hypersensitivity; Female; Humans; Immunologic Factors; Male
PubMed: 32408641
DOI: 10.3390/medicina56050232 -
The Journal of Allergy and Clinical... Aug 2015Allergic reactions to drugs are a serious public health concern. In 2013, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy...
Allergic reactions to drugs are a serious public health concern. In 2013, the Division of Allergy, Immunology, and Transplantation of the National Institute of Allergy and Infectious Diseases sponsored a workshop on drug allergy. International experts in the field of drug allergy with backgrounds in allergy, immunology, infectious diseases, dermatology, clinical pharmacology, and pharmacogenomics discussed the current state of drug allergy research. These experts were joined by representatives from several National Institutes of Health institutes and the US Food and Drug Administration. The participants identified important advances that make new research directions feasible and made suggestions for research priorities and for development of infrastructure to advance our knowledge of the mechanisms, diagnosis, management, and prevention of drug allergy. The workshop summary and recommendations are presented herein.
Topics: Carbamazepine; Dideoxynucleosides; Drug Hypersensitivity; Gene Expression; HLA Antigens; Haptens; Humans; Immunoglobulin E; National Institute of Allergy and Infectious Diseases (U.S.); Practice Guidelines as Topic; Receptors, Antigen, T-Cell; Stevens-Johnson Syndrome; Terminology as Topic; Translational Research, Biomedical; United States; Virus Diseases
PubMed: 26254053
DOI: 10.1016/j.jaci.2015.05.027