ALERGOLOGÍA PARA MÉDICOS Y PACIENTES 2021

Hypersensitivity to β-lactam antibiotics: algorithms of management and desensitization as a vital therapeutic alternative Authors:  Ricardo Cardona, Luis Santamaría, Liliana Guevara-Saldaña, Ana Calle Abstract:  Hypersensitivity reactions can be complex and life-threatening to patients, especially when drugs such as β-lactam antibiotics are involved. To this day, there are diagnostic algorithms and mobile applications that improve the clinical approach, as well as laboratory tests and more specialized procedures, such as skin tests and controlled exposure tests; which are useful for identifying the drug involved and for selecting safe and effective therapeutic alternatives. For several years, the desensitization procedure has been positioned as a vital tool for clinical allergists and for their patients, and it is key to improving clinical outcomes such as survival and quality of life. DOI:   10.29262/ram.v68i1.892

Reactivation of Varicella Zoster Virus after Vaccination for SARS-CoV-2 Authors:  Mina Psichogiou, Michael Samarkos, Nikolaos Mikos, and Angelos Hatzakis Abstract: Seven immunocompetent patients aged > 50 years old presented with herpes zoster (HZ) infection in a median of 9 days (range 7–20) after vaccination against SARS-CoV-2. The occurrence of HZ within the time window 1–21 days after vaccination defined for increased risk and the reported T cell-mediated immunity involvement suggest that COVID-19 vaccination is a probable cause of HZ. These cases support the importance of continuing assessment of vaccine safety during the ongoing massive vaccination for the COVID-19 pandemic and encourage reporting and communication of any vaccination-associated adverse event. DOI:   10.3390/vaccines9060572

 Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs Authors:  Ana Dioun Broyles  1 , Aleena Banerji  2 , Sara Barmettler  2 , Catherine M Biggs  3 , Kimberly Blumenthal  2 , Patrick J Brennan  4 , Rebecca G Breslow  5 , Knut Brockow  6 , Kathleen M Buchheit  4 , Katherine N Cahill  7 , Josefina Cernadas  8 , Anca Mirela Chiriac  9 , Elena Crestani  1 , Pascal Demoly  9 , Pascale Dewachter  10 , Meredith Dilley  1 , Jocelyn R Farmer  2 , Dinah Foer  4 , Ari J Fried  1 , Sarah L Garon  11 , Matthew P Giannetti  4 , David L Hepner  12 , David I Hong  4 , Joyce T Hsu  4 , Parul H Kothari  4 , Timothy Kyin  13 , Timothy Lax  14 , Min Jung Lee  15 , Kathleen Lee-Sarwar  16 , Anne Liu  17 , Stephanie Logsdon  18 , Margee Louisias  4 , Andrew MacGinnitie  1 , Michelle Maciag ...

 Progress in understanding hypersensitivity reactions to nonsteroidal anti-inflammatory drugs Authors: Inmaculada Doña  1   2 , Natalia Pérez-Sánchez  1   2   3 , Ibon Eguiluz-Gracia  1   2 , Rosa Muñoz-Cano  4   5 , Joan Bartra  4   5 , María José Torres  1   2   3   6 , José Antonio Cornejo-García  1 Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross-hypersensitivity reactions (CRs), associated with COX-1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs-exacerbated respiratory disease, NSAIDs-exacerbated cutaneous disease and NSAIDs-induced ur...

 Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012 Authors: N Petitpain  1 , L Argoullon  1 , K Masmoudi  2 , S Fedrizzi  3 , J Cottin  4 , C Latarche  5 , P M Mertes  6 , P Gillet  7 , French Network of Regional Pharmacovigilance Centres Abstract Background: Perioperative anaphylaxis mainly involves neuromuscular blocking agents (NMBAs) with an IgE-mediated mechanism. In France, this life-threatening condition is reported by anesthetists and allergologists, and two safety alerts concerning suxamethonium were raised in 2011 and 2012. This led to start a national survey over the 2000-2012 period which objectives were to provide a descriptive analysis, to estimate incidence rates, and to analyze the trends over this period. Methods: The French pharmacovigilance database was retrospectively queried for all the available NMBAs. Anaphylaxis cases with elevated tryptase and ...

 Paracetamol exposure in pregnancy and early childhood and development of childhood asthma: a systematic review and meta-analysis Authors: M Cheelo  1 , C J Lodge  1 , S C Dharmage  2 , J A Simpson  3 , M Matheson  1 , J Heinrich  4 , A J Lowe  2 Affiliations  expand Abstract Background and objective: While paracetamol exposure in pregnancy and early infancy has been associated with asthma, it remains unclear whether this is confounded by respiratory tract infections, which have been suggested as an alternative explanation. We undertook a systematic review and meta-analysis of longitudinal studies that reported the association between paracetamol exposure during pregnancy or infancy and the subsequent development of childhood asthma (≥5 years). Methods: Two independent researchers searched the databases EMBASE and PUBMED on 12 August 2013 for relevant articles using predefined inclusion and exclusion criteria. Study quality was assessed and r...

 Cross-reactivity in beta-lactams after a non-immediate cutaneous adverse reaction: experience of a reference centre for toxic bullous diseases and severe cutaneous adverse reactions Authors: V. Berot,1 G. Gener,1,2,† S. Ingen-Housz-Oro,1,2,3,† O. Gaudin,1,2 M. Paul,3,4 O. Chosidow,1,2,5 P. Wolkenstein,1,2,5, H. Assier1,2,* Abstract Background Cross-reactivity among beta-lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross-reactivity beyond BLs in patients with non-immediate cutaneous adverse drug reaction (non-immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single-centre study in consecutive patients consulting between 2010 and 2018 with an active BL-suspected non-immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P-IDR)] for at least three penicillin’s subclasses and amino- and non-amino-c...

Pediatric Drug Allergies: Updates on Beta-Lactam, Nonsteroidal Anti-Inflammatory Drug, and Chemotherapeutic Reactions Authors: Shazia Lutfeali  1 , David A Khan  2 Abstract Adverse drug reactions are frequently reported in pediatric patients. In this review article, the authors discuss pediatric drug allergies with emphasis on the most common culprits, beta-lactam antibiotics and non-steroidal anti-inflammatory drugs. The authors also discuss reactions to non-beta-lactam antibiotics and chemotherapeutics. Skin testing has not yet been validated for many drugs, although notable exceptions include penicillin and carboplatin. The gold standard for diagnosis in most cases remains drug challenge, and the need for penicillin skin testing prior to oral provocation challenge has been questioned in recent studies. Successful desensitizations have also been reported with several drugs. Keywords: Beta lactam antibiotics; Chemotherapeutics; Hypersensitivity reactions; Non-beta lactam anti...

 Spanish Guidelines for Diagnosis, Management, Treatment, and Prevention of DRESS Syndrome Authors: R Cabañas 1 2 3 4, E Ramírez 2 3 5, E Sendagorta 3 6, R Alamar 7, R Barranco 3 8 9, N Blanca-López 10, I Doña 11 12, J Fernández 13, I Garcia-Nunez 14, J García-Samaniego 15, R Lopez-Rico 16, E Marín-Serrano 17, C Mérida 18, M Moya 19, N R Ortega-Rodríguez 20, B Rivas Becerra 2 21, P Rojas-Perez-Ezquerra 3 22, M J Sánchez-González 3 23, C Vega-Cabrera 2 21, C Vila-Albelda 24, T Bellón 2 3 25 Abstract Background and objective: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft ...

Drug hypersensitivity in the fast lane: What clinicians should know about phenotypes, endotypes, and biomarkers Authors: Baruch D Jakubovic  1 , Leticia de Las Vecillas  2 , Teodorikez Wilfox Jimenez-Rodriguez  3 , Soledad Sanchez-Sanchez  4 , Mariana Castells  5 Abstract Objective: To review novel concepts in drug hypersensitivity and the management of immediate hypersensitivity reactions. Data sources: English language literature on MEDLINE and Embase surrounding drug hypersensitivity and desensitization. Study selections: References were selected based on relevance, date of publication, and originality. Results: There are numerous citations looking at categorizing drug reactions, pathogenesis, biomarkers, and desensitization. Current understanding supports the use of a phenotype-endotype-biomarker model for categorizing immediate hypersensitivity reactions. Drug desensitization is a powerful therapeutic strategy that enables temporary induction of...

Macrolide Allergic Reactions Authors: Kristy M Shaeer  1 , Elias B Chahine  2 , Sheeba Varghese Gupta  3 , Jonathan C Cho  4 Abstract Macrolides are antimicrobial agents that can be used to treat a variety of infections. Allergic reactions to macrolides occur infrequently but can include minor to severe cutaneous reactions as well as systemic life-threatening reactions such as anaphylaxis. Most reports of allergic reactions occurred in patients without prior exposure to a macrolide. Cross-reactivity among macrolides may occur due to the similarities in their chemical structures; however, some published literature indicates that some patients can tolerate a different macrolide. Most published reports detailed an allergic reaction to erythromycin. Desensitization protocols to clarithromycin and azithromycin have been described in the literature. The purpose of this article is to summarize macrolide-associated allergic reactions reported in published literature...

Glycopeptide Hypersensitivity and Adverse Reactions Authors: Vanthida Huang 1, Nicola A Clayton 2, Kimberly H Welker 3 Abstract Glycopeptides, such as vancomycin and teicoplanin, are primarily used in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections, such as cellulitis, endocarditis, meningitis, pneumonia, and septicemia, and are some of the most commonly prescribed parenteral antimicrobials. Parenteral glycopeptides are first-line therapy for severe MRSA infections; however, oral vancomycin is used as a first-line treatment of Clostridioides difficile infections. Also, we currently have the longer-acting lipoglycopeptides, such as dalbavancin, oritavancin, and telavancin to our armamentarium for the treatment of MRSA infections. Lastly, vancomycin is often used as an alternative treatment for patients with β-lactam hypersensitivity. Common adverse effects associated with glycopeptide use include nephrotoxicity, ototoxicity, and Redman Syndrome (R...

Clinical Characterization and Diagnostic Approaches for Patients Reporting Hypersensitivity Reactions to Quinolones Authors: InmaculadaDoñaMD, PhDabNataliaPérez-SánchezMDabMaríaSalasMD, PhDabEstherBarrionuevoMD, PhDcdArturoRuiz-San FranciscoMDeDoloresHernández Fernández de RojasMD, PhDfgJaumeMartí-GarridoMDgInmaculadaAndreu-RosPhDfRamónLópez-SalgueiroMDfEstherMorenoMD, PhDhiMaría JoséTorresMD, PhDabjk Abstract  Background Quinolones are the second most frequent cause of hypersensitivity reactions (HSRs) to antibiotics. A marked increase in the number of patients with HSRs to quinolones has been detected. Objective To describe the clinical characteristics of patients with HSRs to quinolones and present methods for their diagnosis. Methods Patients attending the allergy unit due to reactions suggestive of HSRs to quinolones were prospectively evaluated between 2005 and 2018. Diagnosis was achieved using clinical history, skin tests (STs), basophil activation tests (BAT...

Opioid Hypersensitivity: Predictors of Allergy and Role of Drug Provocation Testing Authors: Philip H Li  1 , Kok Loong Ue  2 , Annette Wagner  3 , Ryszard Rutkowski  4 , Krzysztof Rutkowski  5 Abstract Background: True IgE-mediated hypersensitivity to opioids is rare and many reactions are due to direct mast cell degranulation. Opioid drug provocation testing (DPT) is the gold standard for diagnosis but is underutilized. Objective: The objective of this study was to evaluate the clinical characteristics and predictors of opioid hypersensitivity, as well as outcomes of opioid DPT. Methods: Patients referred for opioid DPT over the past 9 years were studied. Patient characteristics, indications for opioid use, symptoms of index reaction, and outcomes of DPT were analyzed. Association analysis was performed to study variables associated with a diagnosis of opioid hypersensitivity. Results: Of the total of 98 patients referred with suspected opioid hyp...

Adverse reactions during procedures hypersensitivity to contrast agents and dyes Authors: Christine Schönmann, MD, Knut Brockow, MD  Abstract Objective This review provides an overview of the literature on hypersensitivity reactions during procedures to commonly used contrast agents and dyes. A synthesis of current knowledge on clinical symptoms, epidemiology and risk factors, pathomechanism, and management of hypersensitivity reactions to these substances is presented. Data Sources A literature search was conducted through Medline. Included were peer-reviewed articles written in English between 2000 and 2019. Study Selections Relevant clinical studies, experimental studies, and review articles have been selected. Additionally, case reports have been included if they carried significant information about rare clinical forms of hypersensitivity reactions, disease mechanisms, or therapy. Results An allergological workup is only indicated for patients with...

Secondary prevention measures in anaphylaxis patients: Data from the anaphylaxis registry Authors: Magdalena Kraft et al. Abstract Background Patients with a history of anaphylaxis are at risk of future anaphylactic reactions. Thus, secondary prevention measures are recommended for these patients to prevent or attenuate the next reaction. Methods Data from the Anaphylaxis Registry were analyzed to identify secondary prevention measures offered to patients who experienced anaphylaxis. Our analysis included 7788 cases from 10 European countries and Brazil. Results The secondary prevention measures offered varied across the elicitors. A remarkable discrepancy was observed between prevention measures offered in specialized allergy centers (84% of patients were prescribed adrenaline autoinjectors following EAACI guidelines) and outside the centers: Here, EAACI guideline adherence was only 37%. In the multivariate analysis, the elicitor of the reaction, age of the patient, masto...

Anaphylaxis-a 2020 Practice Parameter Update, Systematic Review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Analysis Authors: Marcus S Shaker 1, Dana V Wallace 2, David B K Golden 3, John Oppenheimer 4, Jonathan A Bernstein 5, Ronna L Campbell 6, Chitra Dinakar 7, Anne Ellis 8, Matthew Greenhawt 9, David A Khan 10, David M Lang 11, Eddy S Lang 12, Jay A Lieberman 13, Jay Portnoy 14, Matthew A Rank 15, David R Stukus 16, Julie Wang 17, Collaborators; Natalie Riblet 18, Aiyana M P Bobrownicki 18, Teresa Bontrager 19, Jarrod Dusin 19, Jennifer Foley 19, Becky Frederick 19, Eyitemi Fregene 18, Sage Hellerstedt 18, Ferdaus Hassan 19, Kori Hess 19, Caroline Horner 20, Kelly Huntington 19, Poojita Kasireddy 18, David Keeler 19, Bertha Kim 18, Phil Lieberman 13, Erin Lindhorst 19, Fiona McEnany 18, Jennifer Milbank 18, Helen Murphy 19, Oriana Pando 18, Ami K Patel 18, Nicole Ratliff 19, Robert Rhodes 19, Kim Robertson 19, Hope Scott 19, Audrey Snell 19, ...

Adverse Side-Effects to Biological Agents Authors: W J Pichler 1 Abstract Biological agents-like cytokines, monoclonal antibodies and fusion proteins are widely used in anti-inflammatory and tumour therapy. They are highly efficient in certain diseases, but can cause a great variety of adverse side-effects. Based on the peculiar features of biological agents a new classification of these adverse side-effects of biological agents is proposed - related but clearly distinct from the classification of side-effects observed with chemicals and drugs. This classification differentiates five distinct types, namely clinical reactions because of high cytokine levels (type alpha), hypersensitivity because of an immune reaction against the biological agent (beta), immune or cytokine imbalance syndromes (gamma), symptoms because of cross-reactivity (delta) and symptoms not directly affecting the immune system (epsilon). This classification could help to better deal with the clinical features...

Alergia a medicamentos Dra. Natalia Aguirre

Antimaláricos en COVID-19 Dr. Stiven Fuentes