Showing papers on "Hypersensitivity reaction published in 2022"
TL;DR: In this article , the authors explored the risk for hypersensitivity with selpercatinib, a first-in-class highly selective and potent, central nervous system-active RET inhibitor, in prior ICI-treated patients with RET fusion-positive NSCLC compared with their ICInaive counterparts.
14 citations
TL;DR: The first case of delayed‐type reaction to non‐hyaluronic acid Polycaprolactone dermal filler after the second dose of Sinopharm COVID‐19 vaccine is presented which was improved with administration of topical and intralesional steroids.
Abstract: Cases of filler reactions after COVID‐19 vaccination have been reported. Here, we present the first case of delayed‐type reaction (DTR) to non‐hyaluronic acid Polycaprolactone dermal filler after the second dose of Sinopharm COVID‐19 vaccine which was improved with administration of topical and intralesional steroids.
14 citations
TL;DR: In this article , a 35-year-old female patient with HBV/HDV-associated compensated cirrhosis had been treated with tenofovir and pegylated interferon alpha (PEG-IFN) since July 2018 and June 2019, respectively.
12 citations
TL;DR: Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare, and multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is (far) higher.
Abstract: The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. 105 drugs were identified that have together caused 536 positive patch tests in 437 patients suffering from DRESS. By far most reactions (n=145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions are anticonvulsants (39%), beta-lactam antibiotics (20%), antituberculosis agents (11%), non-beta-lactam antibiotics (6%) and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta-lactam antibiotics (notably amoxicillin) and possibly iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS, but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is (far) higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing. This article is protected by copyright. All rights reserved.
9 citations
TL;DR: Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare, and multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher.
Abstract: The literature on positive patch test results in drug reaction with eosinophilia and systemic symptoms (DRESS) is reviewed. One hundred and five drugs were identified that have together caused 536 positive patch tests in 437 DRESS patients. By far, the most reactions (n = 145) were caused by carbamazepine, followed by amoxicillin, isoniazid, phenytoin, ethambutol, fluindione, phenobarbital, rifampicin, and ceftriaxone; 43 drugs each caused a single case only. The drug classes causing the highest number of reactions were anticonvulsants (39%), beta‐lactam antibiotics (20%), antituberculosis agents (11%), non‐beta‐lactam antibiotics (6%), and iodinated contrast media (5%). The sensitivity of patch testing (percentage of positive reactions) is high for anticonvulsants (notably carbamazepine), beta‐lactam antibiotics (notably amoxicillin), and, possibly, iodinated contrast media. Allopurinol and sulfasalazine frequently cause DRESS but never give positive patch tests. Patch testing in DRESS appears to be safe, although mild recurrence of DRESS symptoms, mostly skin reactions, may not be rare. Multiple drug hypersensitivity was found to occur in 16% of all patients, but it is argued that the true frequency is higher. Clinical aspects of DRESS, including diagnosing the disease and identifying culprit drugs (patch tests, intradermal tests, in vitro tests, challenge tests) are also provided, emphasizing the role of patch testing.
8 citations
TL;DR: In this paper , the authors report the case of a man who presented to the emergency department with typical angina that started 20 minutes after coronavirus disease 2019 (COVID-19) vaccine administration.
8 citations
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8 citations
TL;DR: It is suggested that patients with a history of immediate hypersensitivity reaction to ciprofloxacin, levofloxac in, and/or moxiflOxacin are at low risk of experiencing a cross-reaction when exposed to a different fluoroquinolone.
Abstract: Abstract Background Fluoroquinolones are the second-most prescribed antimicrobial and are frequently associated with causing hypersensitivity reactions. Existing evidence regarding cross-reactivity of fluoroquinolones is limited, offering clinicians little guidance in understanding the implications of selecting an in-class alternative among patients with histories of allergic reactions to fluoroquinolones. The aim of this study was to compare the frequency of immediate hypersensitivity reactions to ciprofloxacin, levofloxacin, and/or moxifloxacin among patients with a history of immediate hypersensitivity to a different fluoroquinolone. Methods This retrospective chart review included adult patients with a history of an immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin and a documented prescription for a different fluoroquinolone. The primary outcome was documentation of a hypersensitivity reaction upon second fluoroquinolone exposure. Results A total of 321 cases met inclusion criteria. Of these cases, 2.5% experienced an immediate hypersensitivity reaction after second fluoroquinolone exposure to ciprofloxacin, levofloxacin, and/or moxifloxacin. Within the ciprofloxacin, levofloxacin, and moxifloxacin index allergy cohorts, the frequency of cross-reactivity was 2.5%, 2.0%, and 5.3%, respectively. Conclusions Our data suggest that patients with a history of immediate hypersensitivity reaction to ciprofloxacin, levofloxacin, and/or moxifloxacin are at low risk of experiencing a cross-reaction when exposed to a different fluoroquinolone. Avoidance of all fluoroquinolones in this patient population may not be warranted.
7 citations
TL;DR: The Gell and Coombs classification divides immunologic DHRs into four major pathophysiologic categories based on immunologic mechanism as discussed by the authors . But, these categories are not suitable for all patients.
7 citations
TL;DR: The Gell and Coombs classification divides immunologic DHRs into four major pathophysiologic categories based on immunologic mechanism as discussed by the authors. But, these categories are not suitable for all patients and do not always require rapid treatment.
TL;DR: In this article , patch tests, skin prick tests, and intradermal tests are used for adverse drug reactions (ADRs), patch tests have good sensitivity in assessing acute generalized exanthematous pustulosis and drug rash with eosinophilia and systemic symptoms.
TL;DR: The evidence indicates that a combination of prevention strategies using newer antihistamines, H2 antagonists, leukotriene receptor antagonists, and corticosteroids and other interventions used judiciously reduces the occurrence and severity of HSR and improves safety.
TL;DR: Asthma, food allergy, non-allergic drug hypersensitivity and neurologic disease were significantly more frequent in Patients with HRs to GBCM compared to the high evidence of cardiovascular disease and history of cancer in patients withHRs to ICM.
Abstract: Hypersensitivity reactions (HRs) to contrast media (CM) are a major problem. We compared differences of HRs to iodinated contrast media (ICM) versus gadolinium-based contrast media (GBCM), collecting data on prevalence, type, latency and severity. Secondly, the predisposition to perform new contrast tests, use of premedication and possible appearance of new reactions were explored in a long-term follow-up of 5 years. Clinical data, comorbidities, skin test (ST) results, re-exposure to CM procedures with any new reactions, premedication and CM used were collected. In a retrospective single-center study, 350 patients with mild to moderate HRs were enrolled. Asthma, food allergy, non-allergic drug hypersensitivity and neurologic disease were significantly more frequent in patients with HRs to GBCM compared to the high evidence of cardiovascular disease and history of cancer in patients with HRs to ICM. A marked delay in performing STs was reported by patients with negative results (66 months, p < 0.01). Iomeprol, iopamidol and gadobenic acid were the culprit CM most involved in HRs in patients with positive STs. During follow-up, 7.1% of responders reported new HRs to CM despite negative STs, premedication and infusion of alternative CM in most cases.
TL;DR: In this paper , the authors show that assessment by an allergist/immunologist is beneficial for managing patients with previous immediate and non-immediate hypersensitivity reactions to Radiocontrast Media (RCM).
TL;DR: In general, HSRs to fluroquinolones, vancomycin, macrolides, and tetracyclines are challenging to diagnose given the lack of validated skin testing and in vitro testing.
TL;DR: This paper showed that graded dosing of COVID-19 vaccine is safe, efficacious, and useful for treating individuals with severe allergic reactions to the first dose of the vaccine, which is the only guideline that recommends subsequent vaccination.
Abstract: Current guidelines do not recommend subsequent mRNA COVID-19 vaccination in patients who experience immediate allergic reactions to the first dose. Our findings indicate that graded dosing of this vaccine is safe, efficacious, and useful for treating these individuals with allergy.
TL;DR: The aim of this review is to summarize the issues that all relevant staff need to know about and be able to respond to in relation to iodinated contrast media hypersensitivity.
Abstract: At present, iodinated contrast media (ICM) are mostly non-ionic, have low osmolality, and are safe. Even if adverse drug reactions (ADRs) occur, most are chemo-toxic symptoms and require only observation or H1 antihistamines. However, rare, unpredictable, and even life-threatening hypersensitivity can still occur. The aim of this review is to summarize the issues that all relevant staff need to know about and be able to respond to. The most significant risk factor for ICM hypersensitivity is a history of ICM hypersensitivity. For high-risk populations, we must cautiously weigh the advantages and disadvantages of premedication and be aware that breakthrough reactions may still occur. The best policy for patients with a history of severe ICM hypersensitivity is to avoid the same ICM. If ICM are inevitable, skin tests, in vitro tests, and drug provocation tests may help to find a feasible alternative that is safer. The severity of the hypersensitivity is correlated with the positivity rate of these tests, so there is no need for further investigations for patients with only mild reactions. We should also keep in mind that even excipients in ICM may induce hypersensitivity. Detailed, standardized documentation is essential for correct diagnosis and the prevention of future occurrence.
TL;DR: Clinicians should be aware of this rare, but potentially life-threatening, toxicity when using etoposide-based treatments and have procedures in place to urgently manage any hypersensitivity reactions that may occur.
Abstract: Introduction Hypersensitivity reactions from intravenous (IV) etoposide have been rarely reported, with these being seen more commonly with etoposide than with etoposide phosphate. This is generally explained by the need for polysorbate 80, a known cause of hypersensitivity, as a solubiliser, in the etoposide formulation. Case report We report a 22-year-old male, being treated with adjuvant BEP (bleomycin/etoposide phosphate/cisplatin) for a testicular germ cell tumour. Bleomycin and cisplatin were administered without incident. Within one minute of etoposide phosphate commencement he experienced a severe hypersensitivity reaction, consisting of widespread erythematous rash, facial swelling, and nausea. Observations included unrecordable blood pressure, tachycardia, hypoxia, and loss of consciousness, confirming a diagnosis of anaphylactic shock. Management and outcome Etoposide phosphate was ceased immediately. He was successfully managed with IV hydrocortisone, IV promethazine, intramuscular adrenaline, IV fluids and oxygen. Following admission for observation, significant improvement occurred over 48 h. Discussion Hypersensitivity reactions to etoposide were first reported in the 1980s. Following reactions to etoposide, substituting etoposide phosphate into chemotherapy regimens has commonly allowed treatment to continue without incidence. Anaphylactic reactions to etoposide phosphate were first documented in 2012, with further cases reported subsequently. Unlike etoposide, etoposide phosphate is highly soluble in aqueous solutions and doesn't require adjuvants in the formulation. Hypersensitivity reactions to etoposide phosphate are therefore likely related to the etoposide drug molecule itself. Clinicians should be aware of this rare, but potentially life-threatening, toxicity when using etoposide-based treatments and have procedures in place to urgently manage any hypersensitivity reactions that may occur.
TL;DR: Two pediatric cases of Amoxicillin/Clavulanic acid (Augmentin) anaphylaxis resembling Cytokine release syndrome are presented with symptoms suggestive of an acute systemic inflammatory response mimicking sepsis.
Abstract: Cytokine release syndrome (CRS) is a type of hypersensitivity reaction which has been previously described with chemotherapy and monoclonal antibodies, but not with antibiotics. We present 2 pediatric cases of Amoxicillin/Clavulanic acid (Augmentin) anaphylaxis resembling CRS. Both our patients presented during the index reaction with symptoms suggestive of an acute systemic inflammatory response mimicking sepsis. Their symptomology was reproducible at drug provocation test as anaphylaxis, but with suboptimal response to intramuscular adrenaline. Their infective workups were unremarkable and illnesses followed a self-limiting course. All these point towards a severe hypersensitivity reaction resembling CRS.
TL;DR: In this article , the authors evaluated the characteristics of chemotherapeutic drug hypersensitivity reactions and the outcome of desensitization procedures and found that the most common malignancy was colorectal cancer (n:14, 40%).
Abstract: Introduction.Hypersensitivity reactions to chemotherapeutic drugs are increasing all over the world, and desensitization to them has become the standard treatment approach. This study aimed to evaluate the characteristics of chemotherapeutic drug hypersensitivity reactions and the outcome of desensitization procedures. Methods. Between January 2017 and 2019, patients who have been desensitized to chemotherapeutic drugs were included retrospectively. Data were obtained from the medical records of the patients. Results. A total of 35 patients were evaluated; of whom 24 (68.5%) were female and 11 were male (31.5%). The mean age was 54.54 ± 13.39 (min-max: 41-69) years. Colorectal cancer was the most common malignancy (n:14, 40%). Desensitization was performed with oxaliplatin in 17 (48.5%), carboplatin in nine (25.7%), paclitaxel in four (11.4%), cisplatin in two (5.7%), irinotecan in two (5.7%), rituximab in two (5.7%), and docetaxel in one (2.8%) patients. Thirty four (97.1%) were successfully desensitized without any reactions. Anaphylaxis occurred during desensitization with rituximab and the procedure could not be completed. The reactions occurred during the first administration of the chemotherapeutic agent in five (14.2%) patients. Skin tests were performed on 26 (74.2%) patients. Skin prick and intradermal tests were positive in 7 (26.9%) and 12 (46.1%) patients, respectively. Conclusions. Desensitization is an effective and safe treatment approach for chemotherapeutic drug hypersensitivity and can be performed safely by observing general precautions to anaphylaxis.
TL;DR: Sodium 2-mercaptoethane sulfonate (mesna) is a detoxifying agent used to prevent hemorrhagic cystitis in patients receiving chemotherapy with either high-dose cyclophosphamide or ifosfamide as mentioned in this paper .
Abstract: Sodium 2-mercaptoethane sulfonate (mesna) is a detoxifying agent used to prevent hemorrhagic cystitis in patients receiving chemotherapy with either high-dose cyclophosphamide or ifosfamide. It has a reported half-life of 22 minutes, is quickly excreted by the kidneys after infusion, and accumulates in the bladder, where it detoxifies urotoxic breakdown products of cyclophosphamide and ifosfamide.1 Despite multiple reported dosage regimens, mesna is usually administered before or concomitant with the first dose of cyclophosphamide or ifosfamide, followed by bolus doses.
TL;DR: In this article , the authors sought to identify the answers to four questions: 1. what type of cancer has more severe hypersensitivity reactions to Nivolumab, 2. what is the time frame for developing these severe reactions to nivolumaab, 3. whether it is best to continue or stop the treatment after a severe hypersensitive reaction to NIVolumaba, and 4. what severe hypersensation reactions are the most frequent reported along Nivilumab treatment.
Abstract: Immune-checkpoint inhibitors (ICIs) are the most effective treatments nowadays. Nivolumab was the second ICI used for treating solid tumors with amazing results. Patients treated with Nivolumab may react differently to this treatment. Some people tolerate this treatment very well without experiencing any adverse reactions, whilst some may have mild symptoms and a part of them can present severe reactions. In our research, we sought to identify the answers to four questions: 1. what type of cancer has more severe hypersensitivity reactions to Nivolumab, 2. what is the time frame for developing these severe reactions to Nivolumab, 3. whether it is best to continue or stop the treatment after a severe hypersensitivity reaction to Nivolumab and 4. what severe hypersensitivity reactions are the most frequent reported along Nivolumab treatment. This review also highlights another problem with regard to the usage of concomitant and prior medications or other methods of treatment (e.g., radiation therapy), which can also lead to severe reactions. Treatment with Nivolumab is very well tolerated, but patients should also be warned of the possibility of severe hypersensitivity reactions for which they should urgently see a doctor for a personalized evaluation. There are some options for individuals with severe hypersensitivity reactions, for eg. switching the medication or applying a desensitization protocol.
TL;DR: A woman in her 30s with cervical cancer underwent postoperative chemotherapy and showed allergic reactions to multiple taxanes, and a prick test with Cremophor determined that the patient was allergic to pure taxane compounds.
Abstract: A woman in her 30s with cervical cancer underwent postoperative chemotherapy and showed allergic reactions to multiple taxanes. As the patient had infusion reactions to both paclitaxel and docetaxel, a prick test with Cremophor was conducted. In the absence of an allergic reaction to etoposide, we determined that the patient was allergic to pure taxane compounds. Among infusion reactions caused by taxanes, Cremophor allergy is reported in 3% of cases. Therefore, a prick test with Cremophor performed on a taxane infusion reaction will be useful in diagnosing allergy. In addition, allergy due to docetaxel may be managed by adequate premedication and continuous intravenous chlorpheniramine administration.
TL;DR: A case of hypersensitivity reaction in the form of itching and rashes in a 6‐year‐old female patient with a single dose of intravenous ondansetron is presented.
Abstract: Ondansteron is widely used as prophylaxis for postoperative nausea and vomiting and is associated with various side effects. We present a case of hypersensitivity reaction in the form of itching and rashes in a 6‐year‐old female patient with a single dose of intravenous ondansetron.
TL;DR: A case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS was reported in this article , where the patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved.
Abstract: BACKGROUND Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon yet serious adverse drug hypersensitivity reaction with the presentations including rash, fever, lymphadenopathy, and internal organ involvement. Sarcoidosis is a systematic granulomatous disease with unknown etiology. We herein report a case of pulmonary sarcoidosis secondary to allopurinol-induced DRESS. CASE SUMMARY A 37-year-old man with a history of hyperuricemia was treated with allopurinol for three weeks at a total dose of 7000 milligrams before developing symptoms including anorexia, fever, erythematous rash, and elevated transaminase. The patient was diagnosed with DRESS and was treated with prednisone for 6 mo until all the symptoms completely resolved. Three months later, the patient presented again because of a progressively worsening dry cough. His chest computed tomography images showed bilateral lung parenchyma involvement with lymph node enlargement, which was confirmed to be nonnecrotizing granuloma by pathological examination. Based on radiologic and pathological findings, he was diagnosed with sarcoidosis and was restarted on treatment with prednisone, which was continued for another 6 mo. Reexamination of chest imaging revealed complete resolution of parenchymal lung lesions and a significant reduction in the size of the mediastinal and hilar lymph nodes. Following a 6-month follow-up of completion of treatment, the patient's clinical condition remained stable with no clinical evidence of relapse. CONCLUSION This is the first case in which pulmonary sarcoidosis developed as a late complication of allopurinol-induced DRESS. The case indicated that the autoimmune reaction of DRESS may play an important role in the pathogenesis of sarcoidosis.
TL;DR: Knowing the oral clinical signs of this reaction can determine the appropriate treatment plan in handling similar cases, especially in children.
Abstract: Introduction: Food hypersensitivity reaction is a reaction that harms the body to food or food additives whose reactions can be mediated through two different mechanisms, immunological and non-immunological. Objective: This article reports on case and management of hypersensitivity reactions to food. Case: A 10-year-old girl came with thrush on the tongue for 3 days ago, sore and painful; previously consumed traditional fried snack. Ulcerated lesions, multiple, shallow, sunken base with yellowish color surrounded by an erythematous margin on the anterior of the tongue. Total IgE examination was 535.6 IU/mL from the range 0-387 IU/mL. The diagnosis leads to allergic stomatitis. The patient was instructed to apply a tongue compress with hyalu-ronic acid 0.025% mouthrinse then apply triamcinolone acetonide 0.1% in orabase 3 times a day and multivitamin. Conclusion: Knowing the oral clinical signs of this reaction can determine the appropriate treatment plan in handling similar cases, especially in children.
TL;DR: The results show a shift from hapten pattern in mild allergic reactions to p–i pattern in severe life-threatening allergic reactions, which strongly argues against the current preclinical risk evaluation of new drugs based on the ability to form haptens.
Abstract: Rationale β-lactam antibiotics cause drug hypersensitivity reactions (DHR) with various clinical pictures from minor affections like maculopapular exanthema (MPE) and urticaria to severe cutaneous adverse reactions and anaphylaxis. Currently, two different reactivity patterns have been shown to initiate an immune reaction by activating T cells—the hapten concept and the pharmacological interaction with immune receptor (p–i) concept. Objectives In this study, the relationship between the reactivity pattern of drug-reacting T cells of drug allergic patients and their clinical picture has been investigated. Findings Drug-reacting T-cell clones (TCCs) were isolated from patients hypersensitive to β-lactams. Analysis of their reactivity pattern revealed an exclusive use of the hapten mechanism for patients with immediate reactions and for patients of MPE. In patients suffering from drug reactions with eosinophils and systemic symptoms, a severe DHR, analysis of isolated drug-reacting TCC identified the p–i concept as the unique mechanism for T-cell activation. Conclusions The results show a shift from hapten pattern in mild allergic reactions to p–i pattern in severe life-threatening allergic reactions. They strongly argue against the current preclinical risk evaluation of new drugs based on the ability to form haptens.