Poly(vinyl alcohol) and poly(vinyl pyrrolidone) blended films for local nitric oxide release.

The overlabeling of pediatric antibiotic allergy represents a huge burden in society. Given that up to 10% of the US population is labeled as penicillin allergic, it can be estimated that at least 5 million children in this country are labeled with penicillin allergy. We now understand that most of the cutaneous symptoms that are interpreted as drug allergy are likely viral induced or due to a drug–virus interaction, and they usually do not represent a long-lasting, drug-specific, adaptive immune response to the antibiotic that a child received. Because most antibiotic allergy labels acquired in childhood are carried into adulthood, the overlabeling of antibiotic allergy is a liability that leads to unnecessary long-term health care risks, costs, and antibiotic resistance. Fortunately, awareness of this growing burden is increasing and leading to more emphasis on antibiotic allergy delabeling strategies in the adult population. There is growing literature that is used to support the safe and efficacious use of tools such as skin testing and drug challenge to evaluate and manage children with antibiotic allergy labels. In addition, there is an increasing understanding of antibiotic reactivity within classes and side-chain reactions. In summary, a better overall understanding of the current tools available for the diagnosis and management of adverse drug reactions is likely to change how pediatric primary care providers evaluate and treat patients with such diagnoses and prevent the unnecessary avoidance of antibiotics, particularly penicillins.

https://pediatrics.aappublications.org/content/pediatrics/141/5/e20172497.full.pdf

Antibiotic Allergy in Pediatrics

The thiol functional group of the amino acid cysteine can undergo a wide array of oxidative modifications and perform a countless number of physiological functions. In addition to forming covalent cross-links that stabilize protein structure and functioning as a powerful nucleophile in many enzyme active sites, cysteine appears to be the principal actor in redox signaling, functioning as a regulatory reversible molecular switch. It is increasingly appreciated that the thiol group of cysteine in subset of proteins undergoes oxidative modification in response to changes in the intracellular redox environment. To understand these complex but critical biological phenomena, the chemistry of the thiol functionality and related oxidation products must also be taken into consideration. Selective methods to monitor and quantify discrete cysteine modifications will be central to understanding their regulatory and pathophysiologic function. Accordingly, this chapter focuses on the chemical feature of thiol oxidation and on selective methods for detecting oxidants and individual cysteine chemotypes.

Oxidative stress and Redox regulation

Adverse drug reactions (ADRs) represent a major health problem worldwide, with high morbidity and mortality rates. ADRs are classified into Type A (augmented) and Type B (bizarre) ADRs, with the former group being more common and the latter less common but often severe and clinically more problematic due to their unpredictable nature and occurrence at any dose. Pediatric populations are especially vulnerable to ADRs due to the lack of data for this age group from the drug development process and because of the wide use of off-label and unlicensed use of drugs. Children are more prone to specific types of ADRs because of the level of maturity of body systems involved in absorption, metabolism, transportation, and elimination of drugs. This state-of-the-art review provides an overview of definitions, classifications, epidemiology, and pathophysiology of ADRs and discusses the available evidence for related risk factors and causes of ADRs in the pediatric population.

Adverse Drug Reactions in Children: The Double-Edged Sword of Therapeutics.

S-nitrosoglutathione incorporated in poly(ethylene glycol) matrix: potential use for topical nitric oxide delivery.

Discrepancies in the diagnosis and classification of nonsteroidal anti-inflammatory drug hypersensitivity reactions in children.

Background Parent or self-reported drug allergy claims frequently overestimate the real incidence of hypersensitivity reactions. A detailed and algorithmic diagnostic evaluation of drug reactions may allow a proper diagnosis. Objective The aim of this study was to determine the confirmation rates and risk factors for confirmed allergic drug reactions in children. Setting Mersin University Hospital in Turkey. Method The study consisted of children between ages of 8 months and 18 years with the history of suspected drug allergy as reported by the clinician or the patients. Parents were interviewed by a clinician to complete questionnaires that included questions about demographic data and characteristics of index drug reaction. Immediate reactions (IRs) were assessed with immediate-reading skin prick (SPT) and intradermal tests (IDT). Nonimmediate reactions (NIRs) were assessed with SPT, both early and delayed reading of IDT and patch tests. In case of negative skin tests, drug provocation tests were performed. The possible risk factors for confirmed drug allergy in univariate analysis (p < 0.1) were entered into the multivariate logistic regression analysis to determine independent predictors. Main outcome measure (1) Confirmation rates of drug allergy (2) Risk factors related to confirmed drug allergy in children. Results We evaluated a total of 180 suspected drug allergy reactions in 97 children, mainly to antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) and anticonvulsants. Among all suspected allergic drug reactions, 97 (53.9 %) were immediate type and 83 (46.1 %) were non-immediate type. The average time interval between the reaction and allergologic work-up was 5 months. Drug allergy confirmation rates were 30.1 % for beta-lactams, 27.2 % for non-betalactams, 21.1 % for NSAIDs and 30 % for anticonvulsants. Eight of 54 confirmed NIRs showed positivity on immediate skin tests. Regulatory T cells, TGF-β and IL-10 levels were not different between groups with and without confirmed drug allergy. A strong family and personal history of drug allergy were found to be significantly related to the confirmed allergic drug reactions. Conclusion Parent or self-reported drug allergy should be evaluated with a standardized diagnostic work-up before strict prohibitions are made. In addition, family and personal histories of drug allergy were significant risk factors related to allergic drug reactions in children.

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

les auteurs ont etudie le role du metabolisme de l'oxyde nitrique et de la peroxydation de lipides chez des patients atteints de malaria a P. vivax. Les niveaux de nitrite et de nitrate ont ete analyses enutilisant un procede base sur la reaction de Griess et les niveaux de malondialdehyde index de la peroxydation de lipides ont ete determines par la reaction a l'acide thiobarbiturique. Les niveaux de nitrile/nitrate et de malondialdehyde des malades etaient plus eleves que ceux des temoins de facon statistiquement significative (p < 0,001). Cette etude a ete realisee pour determiner si le NO et la peroxydation de lipides s observent au cours du stade sanguin du cycle de P vivax. Il apparait que la peroxydation de lipides s'observe dans la malaria a P. vivax; les niveaux de l'oxyde nitrique etant associes a cette peroxydation.

/pdf/the-role-of-nitric-oxide-and-lipid-peroxidation-in-patients-4x8wdh58gj.pdf

Gulen Aslan

Papers

Discrepancies in the diagnosis and classification of nonsteroidal anti-inflammatory drug hypersensitivity reactions in children.

Diagnostic evaluation and risk factors for drug allergies in children: from clinical history to skin and challenge tests

The role of nitric oxide and lipid peroxidation in patients with Plasmodium vivax malaria.