scholarly journals Prospective study of 5-day challenge with penicillins in children

2020 ◽  
Vol 4 (1) ◽  
pp. e000734
Author(s):  
Birgitte Tusgaard Petersen ◽  
Josefine Gradman
Keyword(s):  
Prospective Study ◽  
Children And Adolescents ◽  
Provocation Test ◽  
Specific Ige ◽  
Hypersensitivity Reactions ◽  
Skin Reactions ◽  
Full Dose ◽  
Culprit Drug ◽  
Drug Provocation Test ◽  
Registration Number

ObjectivesTo examine if a 5-day challenge with penicillin improves the diagnostic sensitivity compared with a single full dose in children with mild skin reactions.DesignSubjects referred with suspected allergy to penicillin were consecutively included. Irrespectively of the morphology of the index reaction and the result of specific IgE, all subjects underwent a two-step titrated drug provocation test (DPT) with the culprit drug followed by a 5-day challenge at home.ParticipantsChildren and adolescents aged 0–18 years referred to allergic workup for penicillin hypersensitivity at two paediatric Danish centres. Only subjects with non-severe skin reactions were included.ResultsA total of 305 subjects were included and 22 (7%) of the DPTs were positive. Three subjects reacted within 1 hour of the first full dose and nine reacted 1–8 hours after the first full dose. Additional 10 positive reactions were observed during the prolonged provocation. Seven subjects reacted after the second full dose and three reacted after 3–6 days. Only mild skin rashes were observed. Eighteen subjects had a specific IgE to a penicillin >0.1 kU/L. Only one of these had a positive DPT.ConclusionIn children, a DPT with penicillins should include at least two full doses. In children with mild hypersensitivity reactions it may be safe to perform DPTs despite a low specific IgE.Trial registration numberNCT04331522

scholarly journals Hypersensitivity Reactions to Monoclonal Antibodies in Children

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 232
Author(s):  
Francesca Mori ◽  
Francesca Saretta ◽  
Annamaria Bianchi ◽  
Giuseppe Crisafulli ◽  
Silvia Caimmi ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Therapeutic Option ◽  
Provocation Test ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Biologic Drugs ◽  
Type Iv ◽  
Drug Provocation Test

Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.

scholarly journals DRUG PROVOCATION TEST AS A DIAGNOSTIC APPROACH FOR HYPERSENSITIVITY REACTION TO ANTITUBERCULOSIS DRUGS: A REPORT OF TWO CASES

2020 ◽  
pp. 1-4 ◽  
Author(s):  
KETUT SURYANA
Keyword(s):  
Therapeutic Approach ◽  
Patient Adherence ◽  
Drug Hypersensitivity ◽  
Public Health Problem ◽  
Provocation Test ◽  
Hypersensitivity Reactions ◽  
Increased Risk ◽  
Drug Provocation Test ◽  
Drug Hypersensitivity Reactions ◽  
Degrees Of Severity

Pulmonary tuberculosis (PTB) continues to be a public health problem, especially in developing countries. The necessity use of multidrug regimens of antituberculosis drug (ATD) in PTB treatment has been associated with increased risk of drug hypersensitivity reactions (DHRs). DHR is a type of unpredictable reaction, refers to immunologically mediated hypersensitivity reactions. It is observed more frequently in the intensive phase of the PTB treatment with varying degrees of severity. DHR can lead to reduce the patient adherence, thereby leading to stoppage of the drugs by the patient. The definite diagnosis based on drug provocation test (DPT) that should be performed at a hospital. The recommended therapeutic approach is rapid desensitization by reintroducing drugs in safety and optimal under threshold dose until usual daily dose is reached. We present two cases of DHR to ATD, DPT as the diagnosis and rapid desensitization as the therapeutic approach.

Intradermal Testing Identifies 1 in 4 Patients with Nonimmediate Penicillin Allergy

2021 ◽  
pp. 1-8
Author(s):  
Sara Fransson ◽  
Holger F. Mosbech ◽  
Jesper Elberling ◽  
Mogens Kappel ◽  
Lene H. Garvey
Keyword(s):  
Skin Testing ◽  
Provocation Test ◽  
Penicillin G ◽  
Control Group ◽  
Skin Reactions ◽  
Intradermal Testing ◽  
Skin Symptoms ◽  
Oral Steroids ◽  
Drug Provocation Test ◽  
Delayed Reactions

<b><i>Background:</i></b> Intradermal testing with delayed reading (IDTdr), used routinely in many centers, may identify delayed reactions to penicillins. However, few studies have compared the results of IDTdr with drug provocation test (DPT). The aim of this study was to examine the proportion of provocation-positive patients testing positive on IDTdr. <b><i>Methods:</i></b> Fifty-seven patients with a positive DPT occurring &#x3e;2 h after intake of penicillin V, dicloxacillin, pivampicillin, or amoxicillin had an IDTdr with penicillin G, amoxicillin, ampicillin, and dicloxacillin. A control group included 18 patients with negative DPTs with the suspected penicillin. <b><i>Results:</i></b> In total 25% (<i>n</i> = 14) of provocation-positive patients tested positive on IDTdr. Among patients with positive IDTdr, 9/14 (64%) versus 11/43 (26%) in the IDTdr negative group (<i>p</i> &#x3c; 0.05) had required oral steroids to treat skin reactions following DPT. No other differences between IDTdr positive and negative groups were found. No controls had a positive IDTdr. <b><i>Conclusion:</i></b> Investigating with IDTdr would have identified 25% of patients with a DPT-verified allergy with delayed reactions. It is difficult to target subgroups who will test positive on IDTdr. There were more patients who tested positive on IDT who had received oral steroids after DPT, and this may be an indication that skin reaction severity plays a role in skin testing diagnostics. Further potential predictors for positivity of IDTdr, such as duration of skin symptoms, should be assessed in large studies in order to optimize the investigations of nonimmediate drug allergic reactions.

scholarly journals Drug-allergy investigation, provocation tests

2021 ◽  
Vol 97 (1) ◽  
pp. 3-10
Author(s):  
Lilla Mihályi ◽  
◽  
Lajos Kemény ◽  
Zsuzsanna Bata-Csörgő
Keyword(s):  
Drug Allergy ◽  
Provocation Test ◽  
Drug Induced ◽  
Intradermal Testing ◽  
Provocation Tests ◽  
Culprit Drug ◽  
Number Of Patients ◽  
Drug Provocation Test ◽  
Perioperative Medication

The authors present the in vivo investigation options in drug allergy. In suspicion of drug induced hypersensitivity reaction prick testing, intradermal testing and patch testing are recommended according to the assumed immuno-mechanism. If these examinations are negative, the next step is the drug provocation test, which is the gold standard in the diagnosis of drug allergy. We summarize methods, indications and contraindications and the evaluationof each test, focusing on issues concerning antibiotics, perioperative medication, local anesthetics and biological agents. There are increasing number of patients presenting hypersensitivity reactions who require proper identification of the culprit drug.

scholarly journals Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

2020 ◽  
Vol 29 (7) ◽  
pp. 227-232
Author(s):  
Teresa Bangerl ◽  
Brigitte Zahel ◽  
Andrea Lueger ◽  
Emmanuella Guenova ◽  
Irena Angelova-Fischer ◽  
...  
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Clinical History ◽  
University Hospital ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Culprit Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

Meloxicam and/or Etoricoxib Could Be Administered Safely in Two Equal Doses during an Open Oral Challenge in Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

2021 ◽  
pp. 1-7
Author(s):  
Dolly Vanessa Rojas-Mejía ◽  
Diana Lucía Silva Espinosa ◽  
Diana Marcela Martínez ◽  
Luis Fernando Ramírez Zuluaga ◽  
Carlos Daniel Serrano Reyes
Keyword(s):  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Descriptive Study ◽  
Oral Challenge ◽  
Oral Drug ◽  
Hypersensitivity Reactions ◽  
Cross Sectional ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

<b><i>Background:</i></b> Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are common. These patients require an effective and safe analgesic alternative. <b><i>Objective:</i></b> The aim of the study was to demonstrate the safety of meloxicam and etoricoxib administered by open oral challenge in 2 equal steps in patients with NSAID hypersensitivity. <b><i>Methods:</i></b> A cross-sectional, descriptive study of patients with a diagnosis of NSAID hypersensitivity who underwent an oral drug provocation test (DPT) with meloxicam or etoricoxib between January 2011 and August 2017 was conducted. The analysis was performed from a database in BD Clinic. <b><i>Results:</i></b> Two hundred and twenty-eight oral provocations were performed with an alternative NSAID (203 with meloxicam and 25 with etoricoxib) in 217 patients with hypersensitivity to NSAIDs. The median age was 38 years. Ninety-eight percent of meloxicam and 100% of etoricoxib DPTs were performed in 2 steps (without previous placebo), and 52% and 64% of meloxicam and etoricoxib DPTs, respectively, were performed with 50% of the therapeutic dose in each step. Tolerance to meloxicam was demonstrated in 192 patients (94.5%) and in 100% of patients receiving etoricoxib. <b><i>Conclusions:</i></b> Open oral provocation with meloxicam and etoricoxib carried out in 2 steps without placebo seems to be safe and implies less costs and less time expenditure. Also, it could be performed with 2 equal doses.

scholarly journals Value of drug provocation test in non-immediate hypersensitivity reactions to betalactams in pediatric age

2018 ◽  
Vol 141 (2) ◽  
pp. AB37 ◽  
Author(s):  
Ana Prieto ◽  
Inmaculada Doña ◽  
Candelaria Muñoz ◽  
María Salas ◽  
Esther Barrionuevo ◽  
...  
Keyword(s):  
Provocation Test ◽  
Hypersensitivity Reactions ◽  
Pediatric Age ◽  
Immediate Hypersensitivity ◽  
Drug Provocation Test

scholarly journals Fixed drug eruption and anaphylaxis induced concurrently by erdosteine: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Da Woon Sim ◽  
Ji Eun Yu ◽  
Young-Il Koh
Keyword(s):  
Case Report ◽  
Drug Eruption ◽  
Provocation Test ◽  
Skin Lesions ◽  
Laryngeal Edema ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Fixed Drug Eruption ◽  
Fixed Drug ◽  
Drug Provocation Test

Abstract Background Erdosteine is used as a mucolytic agent and has a low incidence of adverse drug reactions, most of which are gastrointestinal and mild. Moreover, drug antigens rarely induce multiple simultaneous immunologic reactions. Only one previous case report has demonstrated hypersensitivity reaction induced by erdosteine. Here, we report a case of fixed drug eruption and anaphylaxis, which were concurrently induced by erdosteine. The association between the symptoms and erdosteine was proven by a drug provocation test. Case presentation A 35-year-old woman presented with recurrent angioedema and pruritic rash on the hands, which developed within 2 h following the administration of drugs, including erdosteine, for acute upper respiratory infection. Her rash was characterized by well-defined erythematous plaques, which recurred at the same site following the administration of the medications. She also experienced angioedema of the lips. Fixed drug eruption was considered after excluding other possible causes for the presented skin lesions. A drug provocation test confirmed that fixed drug eruption on both hands had occurred after administration of erdosteine, suggesting that erdosteine was the cause of the allergic reaction. However, she also experienced angioedema, isolated wheal, and laryngeal edema; thus, IgE-mediated type I hypersensitivity could also be concurrently occurring with the fixed drug eruption. Conclusions We report about a patient who was diagnosed with two different hypersensitivity reactions concurrently induced by erdosteine. We also demonstrate that patients may exhibit multiple simultaneous symptoms that usually arise from overlapping of different hypersensitivity mechanisms. Physicians should be aware of the possibility that some patients who are allergic to certain drugs could exhibit several symptoms caused by different mechanisms of hypersensitivity reactions simultaneously.

Evaluation of Hypersensitivity Reactions in Pediatric Patients Using Biological Drugs

2021 ◽  
pp. 1-8
Author(s):  
Ozge Yilmaz Topal ◽  
Volkan Kose ◽  
Banu Acar ◽  
Umut Selda Bayrakci ◽  
Derya Ozyoruk ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Additional Treatment ◽  
Hypersensitivity Reactions ◽  
Biological Drugs ◽  
Rheumatologic Diseases ◽  
Culprit Drug ◽  
Dose Infusion ◽  
History Of ◽  
Oncologic Diseases ◽  
Biologic Drug

<b><i>Introduction:</i></b> Biological drugs are currently used for the treatment of chronic inflammatory, autoimmune, and neoplastic diseases. With their expanding indication spectrum and increasing use, hypersensitivity reactions to these drugs are also becoming more frequent. The present study aimed to report the incidence and the features of such reactions in pediatric patients using biologicals for the treatment of various diseases. <b><i>Methods:</i></b> The medical records of pediatric patients treated with biological agents between October 1, 2011 and August 31, 2019 were reviewed and adverse reactions were evaluated retrospectively. <b><i>Results:</i></b> During the study period, 211 patients (116 boys, 55%) used 21 different biological drugs for the treatment of various diseases. Their median age at the time of the first treatment was 139.9 (IQR: 92.2–187.8) months. Hematologic-oncologic diseases were the most common indication for biological therapy (97/211; 46.0%), followed by rheumatologic diseases (82/211; 38.9%). Of the 211 patients, 14 (6.64%) experienced reactions to biological drugs. The most common culprit agent was rituximab (57.1%). Most of the patients (85.7%) had a history of reactions either during the infusion or within 1 h after taking the drug. Five patients underwent desensitization to the culprit drug, while 7 other patients continued treatment with a reduced dose/infusion rate or premedication. Also 1 patient continued to take the drug without any additional treatment. <b><i>Conclusion:</i></b> It was reported that 6.64% of the patients who received biologic drug therapy for various reasons in our hospital had hypersensitivity. The most common culprit agent was rituximab, and most of the reactions were immediate reactions.

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