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Drug Allergy (drug + allergy)
Selected AbstractsDiagnosis of nonimmediate reactions to ,-lactam antibioticsALLERGY, Issue 11 2004A. Romano Nonimmediate manifestations (i.e. occurring more than 1 h after drug administration), particularly maculopapular and urticarial eruptions, are common during , -lactam treatment. The mechanisms involved in most nonimmediate reactions seem to be heterogeneous and are not yet completely understood. However, clinical and immunohistological studies, as well as analysis of drug-specific T-cell clones obtained from the circulating blood and the skin, suggest that a type-IV (cell-mediated) pathogenic mechanism may be involved in some nonimmediate reactions such as maculopapular or bullous rashes and acute generalized exanthematous pustulosis. In the diagnostic work-up, the patient's history is fundamental; patch testing is useful, together with delayed-reading intradermal testing. The latter appears to be somewhat more sensitive than patch testing, but also less specific. In case of negative allergologic tests, consideration should be given to provocation tests, and the careful administration of the suspect agents. With regard to in vitro tests, the lymphocyte transformation test may contribute to the identification of the responsible drug. Under the aegis of the European Academy of Allergology and Clinical Immunology (EAACI) interest group on drug hypersensitivity and the European Network for Drug Allergy (ENDA), in this review we describe the general guidelines for evaluating subjects with nonimmediate reactions to , -lactams. [source] Oral challenges are needed in the diagnosis of ,-lactam hypersensitivityCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2008P. J. Bousquet Summary Background ,-lactams continue to remain the most commonly involved drug family in allergic drug reactions. They are often essential and there is a cost-effective and favourable risk-benefit ratio for the exploration of all suspicions of ,-lactam allergy. A firm diagnosis is always based on skin tests and sometimes on provocation tests. Recommendations have been published by allergy societies and distinguished scientists but they are not always concordant and can lead to some confusion for the practicing allergologist. The situation has even worsened since the world wide withdrawal of these penicillin determinants and since the predominance of amoxicillin and cephalosporin prescriptions in most countries. Objective , Method In a recent article, it was stated that patients with a penicillin allergy history and negative skin tests to major and minor penicillin determinants are at a low risk of relapse (0,5%) when receiving a ,-lactam. In this paper, our Drug Allergy and Hypersensitivity Database, a cohort database, was used to demonstrate that this statement is false. Standardized European Network for Drug Allergy questionnaires, skin test and challenge procedures were followed. Results One-thousand two-hundred and eighteen subjects, 69.8% of female, 51.7% of atopics, were included. 21.1% had a true ,-lactam allergy confirmed by skin tests (178, 69.3%) or by drug provocation (79, 30.7%). 17.4% of the patients with negative skin tests to major and minor penicillin determinants were positive for a ,-lactam. Conclusion In the diagnosis of ,-lactams allergy, if all skin tests are negative, skin tests with other determinants and provocation tests under strict surveillance are mandatory. [source] Drug allergy and hypersensitivity: still a hot topicALLERGY, Issue 2 2009P.-J. Bousquet First page of article [source] US3 Allergy in dental practiceORAL DISEASES, Issue 2006D Bio, ina-Lukenda Allergy reactions of the oral mucosa comprise an array of clinical manifestations, some of them difficult to differentiate from toxic reactions. Type-I reactions are most frequently seen related to application of polymers in the oral cavity, such as orthodontic bonding and fissure sealant materials. There may also be systemic manifestations such as urticaria. Type-IV reactions may be seen related to most dental materials used, from amalgam and gold to polymers. These reactions appear as chronic reddening and/or ulceration of the oral mucosa. Lichenoid reactions have histopathological characteristics compatible with type-IV allergy reactions and are the most prevalent material-adverse reactions seen in the oral cavity. Recent advances have been made in characterizing the more prevalent allergens on oral mucosa, such as methacrylates, natural rubber latex (NRL) proteins, rubber glove chemicals and disinfectants. This improved understanding has clearly enhanced the success, particularly for type I NRL allergies. Skin patch tests, applying a series of dental materials in non-toxic concentrations on the skin, have been used to identify sensitization. However, the value of those tests can be questioned. Although obvious advances have been made in characterizing dental allergens and understanding potential exposure, improved diagnostic and management techniques are still needed. Corticosteroid therapy is all too often the only treatment. Drug allergy including local anaesthetics, and systemic antibiotics and NSAIDs, may also present in the dental environment, causing life-threatening emergencies specially in 'at risk patients'. The GDP has to know the principles of prevention, diagnosis and management of these situations. [source] Angioedema after administration of methylprednisolone to treat drug allergyALLERGY, Issue 11 2007E. Compalati No abstract is available for this article. [source] Questionnaire-based survey of lifetime-prevalence and character of allergic drug reactions in German childrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 7 2008L. Lange Data on the epidemiology of adverse drug reactions (ADR), especially allergic drug reactions, in children are rare. The reported prevalence of ADR in pediatric populations varies a lot, depending on type of the study and the country where the data were collected. In order to assess the prevalence of ADR and allergic drug reactions in a population of German children, we conducted a study in a German pediatric university hospital. A questionnaire concerning occurrence and character of ADR was distributed to all parents presenting their children in the hospital for planned admissions or in the emergency department from May 2004 to November 2004. Additional telephone interviews were conducted to specify the reported symptoms in ambiguous cases. One thousand four hundred forty-seven questionnaires were collected. The reported life-time prevalence of ADR according to the information given by the parents was 7.5% (108/1447). Six of the reactions were severe, three children had experienced anaphylactic reactions. In 4.2% (61/1447), the history was suspicious for a potential allergic mechanism because of an immediate or late phase cutaneous drug reaction. In this group, the suspected drugs were antibiotics in 85% (32.7% aminopenicillins, 29.5% other penicillins, 11.5% cefaclor, 8.2% macrolides and 18% others), antiphlogistic and respiratory drugs in 4.9% each and vaccines and contrast media in 3.3% each. There was a higher percentage of children under the age of four suffering from ADR. This trend was not significant when analyzing only the allergic reactions. Forty-four percent of the parents stated, their children suffer from drug allergy, although a clear non-allergic reaction was described. Both, ADR and allergic drug reactions are frequent phenomena in children. It is important to monitor drug therapy for any adverse reaction in order to inform the parents about the character of the adverse reaction, the necessary consequences and to initiate further diagnostic procedures. [source] Adverse reactions of anti-tuberculosis drugs in hospitalized patients: incidence, severity and risk factors,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2007Mohammad Reza Javadi Abstract Background Tuberculosis (TB) has been a common chronic infectious disease in human communities. Besides disease-related complications, there could be serious adverse reactions due to anti-tuberculosis (anti-TB) drug therapy. Objectives To assess the incidence and severity of adverse drug reactions (ADRs) induced by anti-TB drugs. To determine possible covariates associated with detected ADRs. Methods All patients with respiratory TB admitted to a teaching hospital who received anti-TB drugs during the research period entered the study and were monitored for ADRs. Socio-demographic and medical history of patients were used as independent covariates. The relationship between independent covariates with frequency and severity of ADRs was analysed using multivariate logistic regression. Preliminary analyses of the Mann,Whitney, Chi-square, Kruskal,Wallis and the Fisher's exact tests were applied to determine factors unlikely associated with the independent variables. Results Among 204 patients admitted, there were 92 patients (45.1%) with ADRs induced by anti-TB drugs. Patients with a previous history of anti-TB drugs usage (OR,=,5.81, 95% confidence interval [95%CI]: 1.31,25.2), patients with a history of drug allergy (OR,=,6.68, CI: 1.28,36.2), those from Afghani ethnic (OR,=,4.91, 95%CI: 1.28,18.30) as well as smoker patients with concurrent diseases (OR,=,19.67, CI: 1.24,341.51) had a higher rate of ADR incidence. Being female (OR,=,1.63, 95%CI: 1.96,36.40) and having previous history of ADR (OR,=,17.46, 95%CI: 1.96,20.42) were identified as risk factors. Conclusion Anti-TB drugs could cause severe and frequent adverse effects. Females, those with a previous history of ADRs to anti-TB drugs and Afghani patients, should be considered as high-risk groups. Copyright © 2007 John Wiley & Sons, Ltd. [source] Pregnancy Complication and Outcome in Women with History of Allergy to Medicinal AgentsAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 2 2010Iris Ohel Citation Ohel I, Levy A, Zweig A, Holcberg G, Sheiner E. Pregnancy complication and outcome in women with history of allergy to medicinal agents. Am J Reprod Immunol 2010; 64: 152,158 Problem, Pregnancy outcome in women with a previous history of drug allergy and the role of drug allergies in adverse pregnancy outcomes is unclear. Method of study, A retrospective cohort study comparing pregnancies of women with and without history of drug allergy was conducted. Data were collected from the computerized perinatal database. A multiple logistic regression model, with background elimination, was constructed to control for confounders. Results, Of 186,443 deliveries, 4.6% (n = 8647) occurred in patients with a history of drug allergy. The following conditions were significantly associated with a history of drug allergy: advanced maternal age, recurrent abortions, fertility treatments, hypertensive disorders, and diabetes mellitus. Using multivariate analysis, with background elimination, history of drug allergy was significantly associated with intrauterine growth restriction (OR = 1.52, CI = 1.3,0.8, P < 0.001) and with preterm delivery (OR = 1.26, CI = 1.14,1.38, P < 0.001). Conclusion, A history of drug allergy is an independent risk factor for intrauterine growth restriction and preterm delivery. Further prospective studies are needed to investigate the nature of this association. [source] Drug allergy claims in children: from self-reporting to confirmed diagnosisCLINICAL & EXPERIMENTAL ALLERGY, Issue 1 2008E. Rebelo Gomes Summary Background Poorly documented self-reported drug allergy (DAll) is a frequent problem in daily clinical practice and has a considerable impact on prescription choices. The diagnostic work-up of drug hypersensitivity (DHs) allows a better classification of the reactions and provides patients with more reliable information and recommendations for future treatments. Objective To assess the prevalence of self-reported adverse drug reactions (ADRs) and DAll in a paediatric population and to investigate children reporting suspected DAll in order to achieve a firm diagnosis. Design The first phase was based on a cross-sectional survey assessing the life occurrence of ADRs and self-reported DAll carried out at the outpatient clinic of a paediatric hospital. The second phase was based on the diagnostic work-up in children with parent-reported DAll, including detailed anamnesis and in vitro and in vivo investigations (skin and provocation tests). Participants One thousand four hundred and twenty-six parents responded to the initial survey. Sixty of the 67 patients with reported DAll were evaluated at the allergy clinic. Results The prevalences of self-reported ADRs and DAll were 10.2% and 6.0%, respectively. Most of the suspected allergic reactions were non-immediate cutaneous events attributable to ,-lactam antibiotics and occurred in very young children. Thirty-nine of the 60 patients consulting for evaluation had a plausible clinical history and were recommended further investigation. DHs was diagnosed in three children only, based on positive responses in skin (n=1) and oral provocation (n=2) tests. Conclusion ADRs are frequently reported in children, and many children are classified as having a DAll. After complete evaluation, only a few of these reactions can be attributed to DHs and DAll. Most of the patients (94% in this study) could actually tolerate the initially suspected drug. [source] | ||||||||||