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International Journal of... 2011Antibiotics are commonly injected during the perioperative period and are responsible of 15 percent of the anaphylactic reactions. Anaphylaxis triggered by antibiotics... (Review)
Review
Antibiotics are commonly injected during the perioperative period and are responsible of 15 percent of the anaphylactic reactions. Anaphylaxis triggered by antibiotics primarily involves penicillin and cephalosporin. The management of patients with histories of allergic reactions to antibiotics is a common situation in clinical practice. The confirmation or invalidation of the allergic nature of the reported reaction is not based on in vitro tests, but on a rigorous allergological work-up based on detailed analysis of clinical history, skin tests and drug provocation test. Considering a possible cross-reactivity between penicillins, once an immediate penicillin allergy has been diagnosed, skin testing with the alternative molecule (cephalosporin, carbapenem, aztreonam) is mandatory and, if negative, the relevant drug should be given in an appropriate setting at increasing doses.
Topics: Anti-Bacterial Agents; Cross Reactions; Desensitization, Immunologic; Drug Hypersensitivity; Humans; Perioperative Period; Skin Tests
PubMed: 22014925
DOI: 10.1177/03946320110240s307 -
CMAJ : Canadian Medical Association... Feb 2019
Topics: Drug Hypersensitivity; Humans; Penicillins; Predictive Value of Tests; Skin Tests; beta-Lactams
PubMed: 30803953
DOI: 10.1503/cmaj.181117 -
European Annals of Allergy and Clinical... May 2016Specific allergen immunotherapy (AIT) is the only therapeutic method with positive impact on natural course of allergic disease - affecting clinical development... (Review)
Review
Specific allergen immunotherapy (AIT) is the only therapeutic method with positive impact on natural course of allergic disease - affecting clinical development (including the progression of rhinitis to asthma) and new sensitisations. The actual problem is the increasing number of patients manifesting poly-sensitivity in allergy skin tests and / or in specific IgE tests. Usually, AIT is not recommended in such individuals. The objective we are facing is that in many patients tested as poly-reactive, we have to distinguish in which cases it is a true polysensitization, and when it is due to cross-reactivity of specific IgE antibodies induced by panallergens. This may really determine when AIT may be an appropriate course of action. The article focuses on this problem in more detail, applying the long time Czech and Slovak experience with allergy testing and allergen immunotherapy.
Topics: Allergens; Asthma; Cross Reactions; Desensitization, Immunologic; Humans; Skin Tests
PubMed: 27152601
DOI: No ID Found -
Giornale Italiano Di Dermatologia E... Oct 2020Adverse drug reactions (ADRs) are common and influence negatively the patient's therapeutic options. They recognize multiple pathogenic mechanisms, some of immunological... (Review)
Review
Adverse drug reactions (ADRs) are common and influence negatively the patient's therapeutic options. They recognize multiple pathogenic mechanisms, some of immunological origin, and the clinical manifestations involve several organs and systems, including skin and/or mucous membranes in 25-30% of patients. The identification of the trigger drug remains a medical challenge, mainly in poly-medicated patients. Anamnesis and clinical approach are crucial, but allergy work-up is the essential tool to confirm or exclude the causative role of the culprit drug. Besides in-vitro tests and drug provocation test, skin tests (ST) represent the cornerstone: patch test in delayed ADR, prick test in immediate ADR, and intradermal test in both. Nevertheless, ST are in continuous evolution and characterized by technical difficulties (concentration and vehicle) that can influence their value and specificity. In this article we review the indications and the rules in performing patch test, prick test, and intradermal test with the most commonly used drugs in Italy to determine the cause of a cutaneous and/or mucous ADR, precise the involved pathogenic mechanism, and provide a valid therapeutic alternative to the patient.
Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Contrast Media; Drug Eruptions; Drug-Related Side Effects and Adverse Reactions; Humans; Skin Tests
PubMed: 32938165
DOI: 10.23736/S0392-0488.20.06698-5 -
Indian Journal of Dermatology,... 2011
Review
Topics: Behcet Syndrome; Exanthema; Humans; Mouth Mucosa; Needles; Skin Tests
PubMed: 21727709
DOI: 10.4103/0378-6323.82399 -
Archives of Toxicology Feb 2019United States regulatory and research agencies may rely upon skin sensitization test data to assess the sensitization hazards associated with dermal exposure to... (Review)
Review
United States regulatory and research agencies may rely upon skin sensitization test data to assess the sensitization hazards associated with dermal exposure to chemicals and products. These data are evaluated to ensure that such substances will not cause unreasonable adverse effects to human health when used appropriately. The US Consumer Product Safety Commission, the US Environmental Protection Agency, the US Food and Drug Administration, the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, and the US Department of Defense are member agencies of the Interagency Coordinating Committee on the Validation of Alternative Methods (ICCVAM). ICCVAM seeks to identify opportunities for the use of non-animal replacements to satisfy these testing needs and requirements. This review identifies the standards, test guidelines, or guidance documents that are applicable to satisfy each of these agency's needs; the current use of animal testing and flexibility for using alternative methodologies; information needed from alternative tests to fulfill the needs for skin sensitization data; and whether data from non-animal alternative approaches are accepted by these US federal agencies.
Topics: Animal Testing Alternatives; Animals; Humans; Skin Tests; United States; United States Government Agencies
PubMed: 30377734
DOI: 10.1007/s00204-018-2341-6 -
Allergy Jan 2023The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and...
BACKGROUND
The diagnosis of allergic reactions to penicillins (AR-PEN) is very complex as there is a loss of sensitization over time, which leads to negative skin tests (STs) and specific IgE in serum, and even to tolerance to the drug involved. However, STs may become positive after subsequent exposure to the culprit drug (resensitization), with the risk of inducing potentially severe reactions. The exact rate of resensitization to penicillins is unknown, ranging from 0% to 27.9% in published studies.
OBJECTIVES
To analyze the rate of resensitization in patients with suggestive AR-PEN by repeating STs (retest) after an initial evaluation (IE).
MATERIAL AND METHODS
Patients with suspected AR-PEN were prospectively evaluated between 2017 and 2020. They underwent STs, and a randomized group also underwent a drug provocation test (DPT) with the culprit. Only patients with negative STs and/or DPT were included. All included cases were retested by STs at 2-8 weeks.
RESULTS
A total of 545 patients were included: 296 reporting immediate reactions (IRs) and 249 non-immediate reactions (NIRs). Eighty (14.7%) cases had positive results in retest (RT+): 63 (21.3%) IRs and 17 (6.8%) NIRs (p < 0.0001). The rate of RT+ was higher in anaphylaxis compared with all other reactions (45.8% vs 9.1%, p < 0.0001). The risk of RT+ was higher from the fifth week after IE (OR: 4.64, CI: 2.1-11.6; p < 0.001) and increased with the patient's age (OR: 1.02; CI: 1.01-1.04; p = 0.009).
CONCLUSIONS
Due to the high rate of resensitization, retest should be included in the diagnostic algorithm of IRs to penicillins after an initial negative study, especially in anaphylaxis, to avoid potentially severe reactions after subsequent prescriptions of these drugs.
Topics: Humans; Anaphylaxis; Skin Tests; Immunoglobulin E; Penicillins; Drug Hypersensitivity; Sodium Tetradecyl Sulfate; Anti-Bacterial Agents
PubMed: 36067012
DOI: 10.1111/all.15508 -
Regulatory Toxicology and Pharmacology... Feb 2023Propylene glycol (PG) has widespread use in pharmaceuticals, cosmetics, fragrances and personal care products. PG is not classified as hazardous under the Globally... (Review)
Review
Propylene glycol (PG) has widespread use in pharmaceuticals, cosmetics, fragrances and personal care products. PG is not classified as hazardous under the Globally Harmonised System of Classification and Labelling of Chemicals (GHS) but poses an intriguing scientific and regulatory conundrum with respect to allergic contact dermatitis (ACD), the uncertainty being whether and to what extent PG has the potential to induce skin sensitisation. In this article we review the results of predictive tests for skin sensitisation with PG, and clinical evidence for ACD. Patch testing in humans points to PG having the potential to be a weak allergen under certain conditions, and an uncommon cause of ACD in subjects without underlying/pre-disposing skin conditions. In clear contrast PG is negative in predictive toxicology tests for skin sensitisation, including guinea pig and mouse models (e.g. local lymph node assay), validated in vitro test methods that measure various key events in the pathway leading to skin sensitisation, and predictive methods in humans (Human Repeat Insult Patch and Human Maximisation Tests). We here explore the possible scientific basis for this intriguing inconsistency, recognising there are arguably no known contact allergens that are universally negative in, in vitro, animal and human predictive tests methods.
Topics: Mice; Humans; Animals; Guinea Pigs; Dermatitis, Allergic Contact; Skin; Allergens; Skin Tests; Patch Tests; Propylene Glycol; Cosmetics
PubMed: 36702195
DOI: 10.1016/j.yrtph.2023.105341 -
Proceedings of the Royal Society of... Feb 1964
Topics: Antitubercular Agents; Child; Diagnosis, Differential; Humans; Infant, Newborn; Lung Diseases; Lymph Nodes; Ophthalmia Neonatorum; Radiography, Thoracic; Sarcoidosis; Skin Tests; Steroids; Tuberculin Test; Tuberculosis; Uveitis
PubMed: 14116030
DOI: No ID Found -
Allergy Apr 2021
Topics: Drug Hypersensitivity; Humans; Hypersensitivity; Hypersensitivity, Immediate; Skin Tests
PubMed: 32780432
DOI: 10.1111/all.14555