Anaphylaxis to Muscle-Relaxant Drugs: Study of Cross-Reactivity by Skin Tests

1991 ◽  
Vol 94 (1-4) ◽  
pp. 349-353 ◽  
Author(s):  
F. Leynadier ◽  
J. Dry
Keyword(s):  
Muscle Relaxant ◽  
Cross Reactivity ◽  
Skin Tests

scholarly journals Allergy to cephalosporin antibiotics in children

2003 ◽  
Vol 131 (3-4) ◽  
pp. 127-130 ◽  
Author(s):  
Marina Atanaskovic-Markovic ◽  
Branimir Nestorovic
Keyword(s):  
Allergic Reaction ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Allergic Reactions ◽  
First Line ◽  
Positive Skin ◽  
Cephalosporin Antibiotics ◽  
The Cross ◽  
Single Blind ◽  
Common Infections

A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children?s Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2 % to 17 %, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1 % to 14.5 %, and among cephalosporins is 0 % to 11.7 %.

scholarly journals Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Manzo Suzuki ◽  
Hajime Kawase ◽  
Azusa Ogita ◽  
Hiroyasu Bito
Keyword(s):  
General Anesthesia ◽  
Skin Testing ◽  
Blocking Agent ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Intradermal Test ◽  
Skin Tests ◽  
Prick Test ◽  
Causative Drug ◽  
Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

scholarly journals Quinolone Allergy

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 97 ◽  
Author(s):  
Edoabasi U. McGee ◽  
Essie Samuel ◽  
Bernadett Boronea ◽  
Nakoasha Dillard ◽  
Madison N. Milby ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Provocation Test ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Diagnostic Tools ◽  
In Vitro Tests ◽  
Allergic Reactions ◽  
Drug Induced ◽  
Delayed Reaction

Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.

Hypersensitivity reactions to low molecular weight heparins: different patterns of cross-reactivity in 3 patients

2018 ◽  
Vol 96 (4) ◽  
pp. 428-432 ◽  
Author(s):  
Danica Juricic Nahal ◽  
Ivana Cegec ◽  
Viktorija Erdeljic Turk ◽  
Ksenija Makar Ausperger ◽  
Iva Kraljickovic ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Challenge Test ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Delayed Type Hypersensitivity ◽  
Low Molecular Weight ◽  
Hypersensitivity Reactions ◽  
Low Molecular Weight Heparins ◽  
Safe Alternative ◽  
Delayed Reactions

Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.

scholarly journals 646. Increasing Use of Interferon-Gamma Release Assay to Test for Pediatric Tuberculosis in a Low-Burden Setting

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S425-S425
Author(s):  
Jeffrey Campbell ◽  
Mingwei Sun ◽  
Wei He ◽  
Gabriella S Lamb ◽  
Gabriella S Lamb ◽  
...  
Keyword(s):  
Interferon Gamma ◽  
Pearson Correlation ◽  
Medication Administration ◽  
Cross Reactivity ◽  
Tuberculosis Infection ◽  
Skin Tests ◽  
Future Research ◽  
Interferon Gamma Release Assay ◽  
Medical Systems ◽  
Interferon Gamma Release Assays

Abstract Background The American Academy of Pediatrics recommends tuberculin skin tests (TSTs) or interferon gamma release assays (IGRAs) to test for tuberculosis (TB) infection in children ≥2 years old, and prioritizes IGRA testing in Bacille Calmette-Guérin vaccine recipients due to cross-reactivity. TSTs require a return visit, which frequently results in loss to follow up. Growing evidence supports accuracy of IGRA testing in pediatric patients, including young children, leading to calls for preferential use of IGRA over TST. We sought to evaluate trends in IGRA use in children over time. Methods We identified all TB infection tests conducted in children 5-17 years old at 2 academic medical systems in Boston from October 2015–January 2021. TSTs were identified using medication administration records, and IGRAs were identified using laboratory records. We computed the proportion of tests per month that were IGRA and TST. We used Pearson correlation to determine the association between month of testing and proportion of tests that were IGRAs. Results 21,471 TB infection tests were obtained from 16,778 patients during our timeframe. Median age of testing was 13.4 years (IQR 9.2 – 16.2 years). During the study period, there was a significant increase in the monthly proportion of TB infection tests that were IGRAs (Pearson correlation coefficient 0.92, P < 0.001). The total number of tests performed per month also increased, with seasonal increases in testing in late summer and early fall and a substantial decline in testing early in the COVID-19 pandemic. Tuberculosis infection tests and proportion IGRA. Total number of tuberculosis infection tests per month and proportion of tests that were interferon gamma release assays, from October 2015 - January 2021. Conclusion Use of IGRAs among patients age 5-17 years of age increased significantly overall and compared to TST in two large Boston healthcare systems over a 5-year period. These results suggest a shift towards blood-based TB infection testing in a low-burden setting, which may improve completion of the pediatric TB infection care cascade. Future research is needed to determine reasons for changing testing modalities, and similar patterns in other settings. Disclosures Gabriella S. Lamb, MD, MPH, Nothing to disclose

Immediate-type hypersensitivity reactions to proton pump inhibitors: usefulness of skin tests in the diagnosis and assessment of cross-reactivity

Allergy ◽  
2013 ◽  
Vol 68 (8) ◽  
pp. 1008-1014 ◽  
Author(s):  
S. Kepil Özdemir ◽  
İ. Yılmaz ◽  
Ö. Aydın ◽  
S. Büyüköztürk ◽  
A. Gelincik ◽  
...  
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Hypersensitivity Reactions

Anaphylactic and Anaphylactoid Reactions Occurring during Anesthesia in France in 1999–2000

2003 ◽  
Vol 99 (3) ◽  
pp. 536-545 ◽  
Author(s):  
Paul Michel Mertes ◽  
Marie-Claire Laxenaire ◽  
François Alla ◽  
Keyword(s):  
Predictive Value ◽  
Immunoglobulin E ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Diagnostic Value ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Skin Tests ◽  
Expert Advice ◽  
Anaphylactoid Reactions

Background Anaphylactic and anaphylactoid reactions occurring during anesthesia remain a major cause of concern for anesthesiologists. The authors report the results of a 2-yr survey of such reactions observed during anesthesia in France. Methods Between January 1, 1999, and December 31, 2000, 789 patients who experienced immune-mediated (anaphylaxis) or nonimmune-mediated (anaphylactoid) reactions were referred to one of the 40 participating centers. Anaphylaxis was diagnosed on the basis of clinical history, skin tests, and/or specific immunoglobulin E assay. Results Anaphylactic and anaphylactoid reactions were diagnosed in 518 cases (66%) and 271 cases (34%), respectively. The most common causes of anaphylaxis were neuromuscular blocking agents (NMBAs) (n = 306, 58.2%), latex (n = 88, 16.7%), and antibiotics (n = 79, 15.1%). Rocuronium (n = 132, 43.1%) and succinylcholine (n = 69, 22.6%) were the most frequently incriminated NMBAs. Cross-reactivity between NMBAs was observed in 75.1% of cases of anaphylaxis to an NMBA. No difference was observed between anaphylactoid and anaphylactic reactions when the incidences of atopy, asthma, or drug intolerance were compared. However, atopy, asthma, and food allergy were significantly more frequent in the case of latex allergy when compared with NMBA allergy. Clinical manifestations were more severe in anaphylaxis. The positive predictive value of tryptase for the diagnosis of anaphylaxis was 92.6%; the negative predictive value was 54.3%. The diagnostic value of specific NMBA immunoglobulin E assays was confirmed. Conclusions These results further corroborate the need for systematic screening in the case of anaphylactoid reaction during anesthesia and for the constitution of allergoanesthesia centers to provide expert advice to anesthesiologists and allergists.

scholarly journals Spanish Society vision of Drug challenge tests

2021 ◽  
Vol 31 (5) ◽  
Author(s):  
A Audicana ◽  
N Ortega ◽  
T Lobera ◽  
N Blanca ◽  
B De la Parte ◽  
...  
Keyword(s):  
Drug Exposure ◽  
Cross Reactivity ◽  
New Drugs ◽  
Skin Tests ◽  
Drug Induced ◽  
Exposure Test ◽  
Immunological Mechanisms ◽  
Specialized Care ◽  
Drug Challenge ◽  
The Individual

The controlled drug exposure test (DPT) is currently considered the gold standard for the diagnosis of drug allergy. Drug-induced adverse reactions (ADRs) are a growing reason for consultation in both primary and specialized care. Allergology consultations in Spain are the ones that usually study these ADRs and rule out immunological mechanisms involved in up to 90% of the cases consulted. An adequate approach to these cases has an obvious impact on the costs and efficacy of the treatments required by other specialists, so that if we did not use DPTs, patients would require more expensive, more toxic and less effective treatments in most of the cases. In recent years, a large number of new drugs have been developed and this document is intended to be a practical guide in the management of PDT with the vision of the Spanish Allergology Society. Diagnostic work begins with a detailed history of the patient. Skin tests are only useful for some medications, and in most cases the diagnosis can only be confirmed by DPT. Although there is usually cross-reactivity, DPTs can confirm the diagnosis and also help to find a tolerable alternative drug. The individual management of patients in a programmed way, taking into account both the type of drug to be studied and the patient's comorbidities, usually allows a solution to be found for the majority of patients.

scholarly journals A Defined Antigen Skin Test for Diagnosis of Bovine Tuberculosis in Domestic Water Buffaloes (Bubalus bubalis)

2021 ◽  
Vol 8 ◽  
Author(s):  
Tarun Kumar ◽  
Mahavir Singh ◽  
Babu Lal Jangir ◽  
Devan Arora ◽  
Sreenidhi Srinivasan ◽  
...  
Keyword(s):  
Skin Test ◽  
Bovine Tuberculosis ◽  
Dairy Farm ◽  
Field Trials ◽  
Bubalus Bubalis ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Point Estimate ◽  
Domestic Water ◽  
Water Buffaloes

Bovine tuberculosis (bTB) remains endemic in domestic water buffaloes (Bubalus bubalis) in India and elsewhere, with limited options for control other than testing and slaughter. The prescribed tuberculin skin tests with purified protein derivative (PPD) for diagnosis of bTB preclude the use of Bacille Calmette-Guérin (BCG)-based vaccination because of the antigenic cross-reactivity of vaccine strains with Mycobacterium bovis and related pathogenic members of the M. tuberculosis complex (MTBC). For the diagnosis of bTB in domestic water buffaloes, we here assessed a recently described defined-antigen skin test (DST) that comprises overlapping peptides representing the ESAT-6, CFP-10 and Rv3615c antigens, present in disease-causing members of the MTBC but missing in BCG strains. The performance characteristics of three doses (5, 10 or 20 μg/peptide) of the DST were assessed in natural tuberculin skin test reactor (n = 11) and non-reactor (n = 35) water buffaloes at an organized dairy farm in Hisar, India, and results were compared with the single intradermal skin test (SIT) using standard bovine tuberculin (PPD-B). The results showed a dose-dependent response of DST in natural reactor water buffaloes, although the SIT induced a significantly greater (P < 0.001) skin test response than the highest dose of DST used. However, using a cut-off of 2 mm or greater, the 5, 10, and 20 μg DST cocktail correctly classified eight, 10 and all 11 of the SIT-positive reactors, respectively, suggesting that the 20 μg DST cocktail has a diagnostic sensitivity (Se) of 1.0 (95% CI: 0.72–1.0) identical to that of the SIT. Importantly, none of the tested DST doses induced any measurable skin induration responses in the 35 SIT-negative animals, suggesting a specificity point estimate of 1.0 (95% CI: 0.9–1.0), also identical to that of the SIT and compares favorably with that of the comparative cervical test (Se = 0.85; 95% CI: 0.55–0.98). Overall, the results suggest that similar to tuberculin, the DST enables sensitive and specific diagnosis of bTB in water buffaloes. Future field trials to explore the utility of DST as a defined antigen replacement for tuberculin in routine surveillance programs and to enable BCG vaccination of water buffaloes are warranted.

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