Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity (original) (raw)
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Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs: An Update
Pharmaceuticals, 2010
After beta lactam antibiotics, hypersensitivity reactions to nonsteroidal antiinflammatory drugs are the second cause of hypersensitivity to drugs. Acute manifestations affect the respiratory tract (aspirin exacerbated respiratory disease), the skin (urticaria and angioedema), or are generalized (anaphylaxis). Correct diagnosis and treatment in order to prevent unnecessary morbidity and the potential risk of death from these severe reactions, and to provide proper medical advice on future drug use frequently requires the participation of allergology specialists familiar with these clinical conditions.
Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions
Romanian Neurosurgery
The role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in neurosurgical practice is a secondary one, however they are still constantly involved in perioperative management of pain or in nonoperative management of acute radiculopathy. Beside the well-known adverse reactions (ADRs), the neurosurgeon practitioner should also take in account the drug hypersensitivity reactions (DHRs) of NSAIDs and be able to deal with it. The aim of this paper was to review the diagnostic and management steps for NSAIDs-induced Hypersensitivity Reactions. The actual stratification of NSAIDs-induced Hypersensitivity Reactions is based on understanding of the heterogeneity of immunological/non-immunological mechanisms of reactions and complexity of clinical manifestations. Practically, this stratification allows the physician to assess suspicion of DHR, based on anamnesis and clinical analysis, and to consider further practical steps to manage and eventually confirm the diagnosis. Drug allergies are co...
Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs
Current Drug Metabolism, 2009
NSAIDs are the most important group of drugs involved in hypersensitivity drug reactions, and include heterogeneous compounds with very different chemical structures. These reactions can be IgE dependent (immediate reactions), T cell-mediated (nonimmediate), or induced by a non-specific immunological mechanism related with the blocking of the COX-1 enzyme and the shunting to the lipooxygenase pathway (cross-intolerant reactions).
Acta dermatovenerologica Croatica : ADC, 2009
Urticaria and angioedema are common allergic manifestations and medications are one of common triggering factors. The most severe immediate drug reaction is anaphylaxis. Apart from the well established IgE-mediated immediate type hypersensitivity reactions, the pathogenesis of drug-induced urticaria, angioedema and anaphylaxis often remains obscure. In this article, emphasis is put on nonallergic reactions to the most commonly used drug groups of nonsteroidal antiinflammatory drugs, angiotensin-converting enzyme inhibitors, radiocontrast media, volume expanders and drugs used in general anesthesia. Urticaria is the second most common drug eruption after maculopapular exanthema. The mechanisms of acute urticarial reactions are multiple, mostly IgE mediated, but some drugs can induce immune complex reactions and activate complement cascade, while others can induce direct activation of mast cells and degranulation or activation of complement by non-immune mechanisms. With different typ...
Selective immediate hypersensitivity reactions to NSAIDs
Current Opinion in Allergy & Clinical Immunology, 2009
Purpose of review Selective immediate reactions to NSAIDs imply that patients develop a urticarial/ anaphylactic response to a single drug with good tolerance to other compounds. No systematic review of these reactions has yet been made. Recent findings With the increase in consumption of NSAIDs, these have become one of the most common drugs inducing hypersensitivity reactions. Although cross-intolerance reactions are the most common, a significant proportion is selective responses. As specific IgE antibodies are not always found, there is only indirect evidence supporting an IgE-mediated mechanism in selective NSAID reactors. Summary Selective immediate reactions to NSAIDs must be considered when a patient develops urticaria or anaphylaxis after intake of one drug with good tolerance to drugs from other groups or even a drug from the same group with a slightly different chemical structure. Further research is required to identify the antigenic determinant structures recognized.
The multiple faces of nonsteroidal antiinflammatory drug hypersensitivity
2004
Summary. Based on the clinical picture and triggering drugs, allergic and pseudoallergic adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) can be classified in four patterns : respiratory, cutaneous, mixed and systemic. This categorization is useful for the purpose of describing patient populations included in studies about NSAID adverse reactions as well as for the routine management of the patient in
Editorial: Drug Hypersensitivity: From Mechanisms to Improved Diagnosis and Standards of Care
Frontiers in Pharmacology, 2021
Editorial on the Research Topic Drug Hypersensitivity: From Mechanisms to Improved Diagnosis and Standards of Care Adverse drugs reactions occur in 10-15% of hospitalized patients and cause 3-6% of hospital admissions, constituting adn important public health issue (Doña et al., 2012). Some of them are unpredictable and occur after exposure to a drug at doses normally tolerated. These reactions, called drug hypersensitivity reactions (DHRs), can be immunologically mediated (allergic reactions) or non-immunologically mediated (non-allergic hypersensitivity reactions), which comprise most reactions induced by nonsteroidal anti-inflammatory drugs (NSAIDs) (Pichler, 2019). Their diagnosis and management is complex due to the lack of knowledge about underlying mechanisms, immunochemistry of the drugs that identify the epitope finally recognizes by the immunological system, variety of clinical symptoms, and heterogeneity among diagnostic protocols used in different centers (Torres et al., 2019). Therefore, an update on drug pharmacology, DHR classifications and mechanisms, and development of new tools and protocols to improve diagnosis and management is essential. Regarding epidemiology, in a prospective study of 1,553 Kuwaiti patients reporting DHRs, performed by Al-Ahmad et al., NSAIDs and betalactams (BLs) were confirmed as the most commonly implicated drugs. In particular, reactions to BLs were mainly immediate (i.e., occurring within 1 h after drug administration) and the most common symptoms were urticaria, angioedema, and respiratory ones. In patients with DHRs, diagnostic procedures must be performed by trained personnel in specialized facilities. These procedures include detailed clinical history, in vivo tests, mainly skin (STs) and drug provocation tests (DPTs), and in vitro assays (Romano et al., 2020). However, the allergy work-up of DHRs inevitably involves costs (Sobrino et al., 2020). In this regard, Sobrino-García et al. analyzed 20 studies regarding the costs of drug hypersensitivity assessment, especially those associated with mislabeling in NSAID or BL hypersensitivity. Their analysis revealed that the diagnosis of DHRs is not expensive, particularly considering the economic and clinical consequences of labeling patients with DHRs. Indeed, proper diagnostic work-ups of DHRs can save money to the health systems. Nevertheless, the current diagnostic tests are not 100% sensitive (Mayorga et al., 2016). Regarding BLs, the chemical stability of benzylpenicillin reagents used for STs, the best validated in vivo method for immediate reactions to BLs, is essential to improve sensitivity. Mayorga et al. noted that butylamine-benzylpenicilloyl conjugates, present in commercial kits for STs, can
Allergy, 2013
Hypersensitivity reactions to aspirin (acetylsalicylic acid) and other nonsteroidal anti-inflammatory drugs (NSAIDs) constitute only a subset of all adverse reactions to these drugs, but due to their severity pose a significant burden to patients and are a challenge to the allergist. In susceptible individuals, NSAIDs induce a wide spectrum of hypersensitivity reactions with various timing, organ manifestations, and severity, involving either immunological (allergic) or nonimmunological mechanisms. Proper classification of reactions based on clinical manifestations and suspected mechanism is a prerequisite for the implementation of rational diagnostic procedures and adequate patient management. This document, prepared by a panel of experts from the European Academy of Allergy and Clinical Immunology Task Force on NSAIDs Hypersensitivity, aims at reviewing the current knowledge in the field and proposes uniform definitions and clinically useful classification of hypersensitivity reac...
Flucloxacillin Hypersensitivity: Patient Outcomes in a Multicenter Retrospective Study
The Journal of Allergy and Clinical Immunology: In Practice, 2019
What is already known about this topic? To date, no large cohorts of either immediate or nonimmediate flucloxacillin hypersensitivity have been reported. What does this article add to our knowledge? Nearly two-third of patients with immediate flucloxacillin hypersensitivity were selective reactors on skin testing. This highlights the importance of drug provocation test with an alternative penicillin in these patients. In contrast, most patients with nonimmediate hypersensitivity were cross-reactors on skin testing. How does this study impact current management guidelines? Broad penicillin avoidance may not be necessary in all patients with immediate flucloxacillin hypersensitivity. Standardized approaches to testing and challenge are needed. BACKGROUND: Flucloxacillin is a narrow-spectrum, beta-lactamaseeresistant penicillin. Type I (IgE-mediated) and type IV (T-cellemediated) reactions are less frequently reported than with other penicillins. OBJECTIVE: To undertake a detailed clinical characterization of a cohort of patients referred with suspected flucloxacillin hypersensitivity. METHODS: We retrospectively analyzed demographic characteristics, presentation, investigation, and management of 108 patients presenting to 4 UK centers. Patients underwent skin prick and intradermal testing with flucloxacillin, major (benzylpenicilloyl poly-L-lysine) and minor determinants, amoxicillin, and benzylpenicillin with immediate and, where appropriate, delayed reading of the test. In the immediate group, a further 14 patients were tested to ampicillin and 16 to Augmentin (co-amoxiclav-combination of clavulanic acid and amoxicillin). Skin testenegative patients underwent oral drug provocation. A multistep protocol was used, depending on risk assessment. RESULTS: Forty of 108 (37%) patients were diagnosed with hypersensitivity to flucloxacillin, of whom 33 (82.5%) showed immediate and 7 (17.5%) nonimmediate hypersensitivity, respectively. In the immediate group, most reactions were severe: 19 of 33 (58%). Intradermal testing had a higher negative predictive value (86%) in the immediate group than in the nonimmediate group (67%). Only a minority of patients (6 of 17 [35%]) with IgE-mediated allergy were cross-sensitized on intradermal testing with other penicillins, compared with 3 of 4 (75%) in the delayed group. CONCLUSIONS: Immediate hypersensitivity reactions to flucloxacillin are more common than delayed. Crosssensitization to other penicillins appears higher in delayed reactions than in immediate. The negative predictive value of intradermal testing is higher in the immediate group than in the nonimmediate group. Drug provocation testing remains the diagnostic criterion standard.