scholarly journals Expedited Desensitization to Canakinumab

2020 ◽  
Vol 11 ◽  
pp. 215265672093769 ◽  
Author(s):  
Neha Sanan ◽  
Jason Schend ◽  
Marija Rowane ◽  
Robert Hostoffer
Keyword(s):  
Inflammatory Diseases ◽  
Interleukin 1 ◽  
Alternative Therapy ◽  
Prior History ◽  
Intradermal Testing ◽  
Immune Modulators ◽  
Fever Syndromes ◽  
Gastrointestinal Intolerance ◽  
History Of ◽  
Desensitization Protocol

Introduction Interleukin-1 (IL-1) antagonists have been successful in the management of monogenic auto-inflammatory diseases, notably classic hereditary fever syndromes, such as Familial Mediterranean Fever (FMF). Anakinra (Kineret®), a human recombinant IL-1 receptor antagonist (IL-1Ra), has been clinically effective in the management of persistent auto-inflammation, such as FMF. Few studies report anaphylaxis in response to anakinra, which were resolved with an anakinra desensitization or the anti-IL-1β monoclonal antibody canakinumab (ILARIS®). We describe the first reported desensitization protocol to canakinumab. Case Report A 51-year-old man with a prior history of FMF presented with history of failed colchicine, nonsteroidal anti-inflammatory drug, and anakinra trials. Anakinra desensitization and canakinumab intradermal testing (IDT) resulted in anaphylactic and allergic symptoms, respectively. Expedited desensitization to canakinumab was successfully performed with 15-minute intervals between 13 doses of incremental increase to 150 mg. Discussion Biological agents are immune modulators that may evoke unanticipated hypersensitivity reactions, including anaphylaxis. These anaphylactic reactions to biologics have been infrequently reported, but the expanding market may increase the risk of IgE-mediated hypersensitivities and subsequent need for desensitization protocols. The current, expedited desensitization evaluated several published protocols involving anakinra desensitization to determine appropriate dosing for canakinumab. Conclusion We report the gastrointestinal intolerance and continued FMF flares on colchicine, followed by anaphylactic responses to anakinra and allergic reaction to IDT of canakinumab, in the present case of FMF. Our novel, expedited canakinumab desensitization protocol serves as an effective and alternative therapy in cases when other appropriate biologic agents are not tolerated.

Oxaliplatin desensitization after hypersensitivity reaction: A single-center experience on more than 300 procedures.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 610-610 ◽  
Author(s):  
Florence Le Roy ◽  
Eugénie Rigault ◽  
David Regnault ◽  
Nicole Hubert ◽  
Pascal Burtin ◽  
...  
Keyword(s):  
Hepatic Arterial Infusion ◽  
Prior History ◽  
Intravenous Route ◽  
Arterial Infusion ◽  
Single Center Experience ◽  
History Of ◽  
Desensitization Protocol ◽  
Grade 3 ◽  
Inpatient Basis ◽  
Severe Grade

610 Background: Oxaliplatin is an essential drug in gastrointestinal oncology. Hypersensitivity reactions (HSR) occur frequently (incidence varying from 10% to 25%), leading to permanent treatment discontinuation. The present study aimed to report our experience of oxaliplatin desensitization in patients with history of HSR to oxaliplatin. Methods: We retrospectively reviewed all patients who received at least one infusion of oxaliplatin according to a desensitization protocol after prior history of HSR to oxaliplatin, from June 2011 until June 2017. HSRs were classified from NCI CTC-AE grade 1 (transient rash, fever < 38°C) to grade 4 (anaphylaxis). We applied in all cases a desensitization protocol in which the oxaliplatin infusion rate is gradually increased from 1mL/hr. to 150mL/hr., on an inpatient basis. Intravenous or hepatic arterial infusion was used depending on clinical setting. Results: Overall, 54 patients were included in this study, in whom HSR to oxaliplatin occurred after a median of 9 infusions (range, 1-31). The severity of HSRs was grade 1-2 in 33 patients (61%) and grade 3-4 in 21 patients (39%). A total of 305 oxaliplatin infusions according to a desensitization protocol were performed in these 54 patients (median, 5 infusions; range, 1-20). These infusions were by intravenous route in 42 patients (78%), by hepatic arterial route in 11 patients (18%), and both in 2 patients (4%). Infusions were well tolerated in 41 patients (76%), without new HSR. The remaining 13 patients (24%) experienced HSR recurrence (grade 2, 9 patients [69%]; grade 3, 4 patients [31%]). No anaphylaxis or oxaliplatin-related death occurred. In the 21 patients with a prior history of severe (grade 3-4) HSR, oxaliplatin desensitization procedure was effective and sustained in 16 patients (79%). Among 32 evaluable patients, 23 (72%) experienced disease control (14 partial responses, 9 stable diseases). Conclusions: Rechallenging Oxaliplatin desensitization procedure was successful in three out of four patients with prior history of HSR to oxaliplatin. Our retrospective study confirms that oxaliplatin desensitization is safe, and allows patients who developed HSR to continue an effective treatment.

scholarly journals Intestinal Amyloidosis in Common Variable Immunodeficiency and Rheumatoid Arthritis

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
T. Meira ◽  
R. Sousa ◽  
A. Cordeiro ◽  
R. Ilgenfritz ◽  
P. Borralho
Keyword(s):  
Rheumatoid Arthritis ◽  
Common Variable Immunodeficiency ◽  
Chronic Diarrhea ◽  
Inflammatory Diseases ◽  
Amyloid Deposition ◽  
Prior History ◽  
Chronic Inflammatory Diseases ◽  
Reactive Amyloidosis ◽  
History Of ◽  
Common Variable

We present a case of reactive amyloidosis that developed secondary to common variable immunodeficiency and rheumatoid arthritis. A 66-year-old woman, with prior history of common variable immunodeficiency and rheumatoid arthritis, was referred to our clinic for chronic diarrhea investigation. The patient was submitted to colonoscopy with ileoscopy, which did not show relevant endoscopic alterations. However, undertaken biopsies revealed amyloid deposition. Since amyloidosis with GI involvement is a rare cause of chronic diarrhea, this pathology should be considered in etiologic investigation, especially when associated with chronic inflammatory diseases.

scholarly journals Modified Oral Metronidazole Desensitization Protocol

2014 ◽  
Vol 5 (2) ◽  
pp. ar.2014.5.0080 ◽  
Author(s):  
Samantha R. Gendelman ◽  
Lily C. Pien ◽  
Ravi C. Gutta ◽  
Susan R. Abouhassan
Keyword(s):  
Nasal Congestion ◽  
Skin Tests ◽  
Positive Skin ◽  
Intradermal Testing ◽  
History Of ◽  
Desensitization Protocol ◽  
Ige Mediated ◽  
Systemic Symptoms ◽  
Oral Metronidazole ◽  
Oral Desensitization

The Center for Disease Control guidelines recommend desensitization to metronidazole in patients with trichomoniasis and hypersensitivity to metronidazole. There is only one published oral metronidazole desensitization protocol. The purpose of this study was to design a new, more gradual oral desensitization protocol to decrease systemic reactions that may occur when using the previously published protocol. We present two patients with presumed IgE-mediated allergy to metronidazole who underwent oral desensitization using our modified protocol. Case 1 was a 65-year-old woman with trichomoniasis who presented for metronidazole desensitization with a history of intraoperative anaphylaxis and positive skin tests to metronidazole. The patient tolerated six doses of the modified desensitization but developed systemic symptoms of nasal congestion and diffuse pruritus after the 25- and 100-mg doses. Both reactions were treated with intravenous (i.v.) antihistamines. Because of gastrointestinal irritation, the desensitization was completed at a dose of 250 mg orally every 6 hours. Case 2 was a 42-year-old woman with trichomoniasis and a history of hives immediately after administration of i.v. metronidazole who presented for desensitization. The patient had negative skin-prick and intradermal testing to metronidazole. She developed lip tingling and pruritus on her arms 15 minutes after the 10-mg dose. Fexofenadine at 180 mg was given orally and symptoms resolved. She tolerated the rest of the protocol without reaction and received a total dose of 2 g of metronidazole. Our oral metronidazole desensitization for presumed IgE-mediated reactions offers a second option for physicians wishing to use a more gradual escalation in dose.

scholarly journals 1028. Dalbavancin Use in Complicated Infections and-associated Cost-Savings

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S362-S362 ◽  
Author(s):  
Amber C Streifel ◽  
Monica Sikka ◽  
Monica Sikka ◽  
James Lewis
Keyword(s):  
Soft Tissue ◽  
Social Issues ◽  
Treatment Options ◽  
Alternative Therapy ◽  
Cost Savings ◽  
Prior History ◽  
Inpatient Setting ◽  
Soft Tissue Infections ◽  
Cost Avoidance ◽  
History Of

Abstract Background Dalbavancin is a lipoglycopeptide antibiotic active against Gram-positive organisms with an extended half-life that allows for weekly dosing. Initially approved for treating skin and soft-tissue infections, use for more complicated infections provides several potential benefits, particularly in the outpatient setting when daily intravenous antibiotics are not practical due to social or financial issues. Methods We conducted a retrospective study to describe dalbavancin use at our institution and to estimate resulting cost avoidance. We identified all patients aged 18 years or older who received at least one dose of dalbavancin via medication records, regardless of setting. Results 46 patients received dalbavancin between April of 2015 and March of 2019. The most commonly treated infections were bone and joint infections (41%), complicated bacteremias (24%), and skin and soft-tissue infections (20%). The most commonly treated organism was Staphylococcus aureus (55%). A variety of dosing regimens were used, 26 patients (57%) received a single dose to complete a treatment course. The majority of doses were administered in an outpatient infusion center (61%) although 28% of doses were administered in the inpatient setting prior to discharge. Reasons for dalbavancin selection included history of intravenous drug use (35%), contraindications to alternative antibiotics (30%), prior history of nonadherence or manipulation of PICC (18%), other social issues preventing PICC (11%), and limited outpatient daily infusion options due to lack of funding (9%). 4 patients (8.7%) were lost to follow-up. 11 (24%) patients were readmitted to the hospital within 30 days, 2 (4%) of these patients were readmitted with a concern related to their infection or an adverse effect of the dalbavancin infusion. Based on a calculation of equivalent dalbavancin therapy days for each patient, 774 hospital days were saved. In total, this is estimated to be $1,885,479 in overall cost avoidance and a mean cost avoidance of $40,988 per patient. Conclusion As data regarding the efficacy of dalbavancin for more complicated infections continue to emerge, it should be considered as a cost-effective alternative therapy when social and financial factors limit treatment options. Disclosures All authors: No reported disclosures.

Humoral factors of innate immunity in the saliva of patients with infectious inflammatory respiratory diseases

2018 ◽  
pp. 13-17
Author(s):  
Oleg Melnikov ◽  
Diana Zabolotnaya ◽  
Alexander Bredun ◽  
Bogdan Bil ◽  
Oksana Rylska ◽  
...  
Keyword(s):  
Innate Immunity ◽  
Chronic Rhinosinusitis ◽  
Inflammatory Diseases ◽  
Activity Level ◽  
Chronic Tonsillitis ◽  
Control Group ◽  
Quantitative Composition ◽  
Upper Airways ◽  
Humoral Factors ◽  
Immune Modulators

Introduction: In recently ears factors of innate immunity both cellular and humoral have been paid considerable attention as they are a protective barrier of a fast response and that is why they are largely concentrated at the intersection of the digestive tract and airways. The data concerning the activity level of factors of innate immunity in the upper airways affected by nonspecific inflammatory processes is insufficient and sparse and therefore the purpose of this research was to study the content of humoral factors of innate immunity in the oropharyngeal secretion (ORS) of patients with chronic infectious inflammatory diseases of the upper airways in remission. Materials and Methods: There was an examination of 16 patients with chronic rhinosinusitis (CRS) of bacterial genesis (15-40 years old), 12 patients with rhinopharyngitis of post-viral genesis (8-16 years old), 12 people with scleroma from 30 tо 52 years of age (atrophic form), 10 patients with chronic tonsillitis in remission (from 10 to 33 years of age) and 11 patients of a control group (practically healthy donors from 12 tо 40 years of age). The content of MIP-1b, defensin-1β, lactoferrin, lysozyme, α-interferon was studied in the nonstimulated OPS. Statistics were carried out using Mann-Whitney U-test. Results: The greatest number of deviations in the decrease in the content of the examined nonspecific protective factors was found in cases of scleroma, chronic tonsillitis and chronic rhinosinusitis (p<0,05). The lack of protective humoral factors of innate immunity can be evidence of local immunodeficiency even in remission, which is a pathophysiological component of the maintenance of chronic inflammation. Conclusion: The decrease int he quantitative composition of factors of innate immunity in the oropharyngeal secretion of patients with chronic infectious inflammatory diseases of the airways is an objective ground not only for a replacement therapy, but also for the use of immune response modifiers from photo-immune modulators to “genuine immune modulators” controlling the state of the factors of both innate immunity and immunoglobulins, primarily of secretory type, the level and functionality of various groups of immunocompetent and accessory cells.

High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 250-257 ◽  
Author(s):  
Jiann-Der Lee ◽  
Ya-Han Hu ◽  
Meng Lee ◽  
Yen-Chu Huang ◽  
Ya-Wen Kuo ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Multivariate Logistic Regression Analysis ◽  
Stroke Recurrence ◽  
Prior History ◽  
Multivariate Logistic Regression ◽  
Cart Analysis ◽  
Younger Age ◽  
History Of ◽  
One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

RISK FACTORS IN THE DEVELOPMENT OF LIVER ABSCESSES AND DIAGNOSTIC STRATEGY IN THEIR SUSPECTED PRESENCE

2016 ◽  
Vol 2 (1) ◽  
pp. 31
Author(s):  
Josiah Iju WILSON ◽  
Vladimir Egorovich MEDVEDEV
Keyword(s):  
Risk Factors ◽  
Clinical Laboratory ◽  
Inflammatory Diseases ◽  
Bacterial Overgrowth ◽  
Diagnostic Strategy ◽  
Hydrogen Breath Test ◽  
Severe Condition ◽  
Liver Ultrasound ◽  
Liver Abscesses ◽  
History Of

Introduction: The main risk aetiological factors of liver abscesses and development of precision liver ultrasound recommendations to detect signs of possible abscess formation were studied.Material and methods: 248 patients of both sexes aged 4-81 years with liver abscesses were analyzed. Medical history, physical examination, clinical laboratory tests, hydrogen breath test with, ultrasound examination, if necessary - computed tomography and fine needle diagnostic biopsy under ultrasound guidance were carried out..Results and discussion: It was established that liver abscesses are aetiologically heterogeneous, in which the largest in the group was pylephlebitic (64.1%), posttraumatic (14.5%), cholangiogenic (12.5%) and contact abscesses (1.2 %). In connection with the effacement or nonspecific clinical picture, often severe condition of the patient, the prevalence of symptoms in some cases of other diseases, liver abscesses may not be promptly diagnosed.Conclusion: The presence of clinical and laboratory signs of suppurate inflammatory processes, risk factors such as the presence of bacterial overgrowth syndrome, inflammatory diseases of the intestines, history of the use of proton pump inhibitors, diseases in association with cholestasis, surgery, history of trauma, abscesses of other locations, it is recommended that precision liver ultrasound should be carried out to detect possible echo signs of liver abscesses.

Dysbaric osteonecrosis associated with decompression sickness in a fishing diver

2019 ◽  
pp. 217-220
Author(s):  
Eduardo Briceño-Souza ◽  
◽  
Nina Méndez-Domínguez ◽  
Ricardo j Cárdenas-Dajda ◽  
Walter Chin ◽  
...  
Keyword(s):  
Femoral Head ◽  
Decompression Sickness ◽  
Small Scale ◽  
Prior History ◽  
Radiological Findings ◽  
Small Scale Fisheries ◽  
Left Limb ◽  
History Of ◽  
Decompression Stress ◽  
Probable Diagnosis

Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.

Role of Cervical Cytology in Surveillance after a Radical Trachelectomy in Patients with a Prior History of Cervical Cancer

2016 ◽  
Vol 143 (1) ◽  
pp. 204-205
Author(s):  
J.S. Shah ◽  
A.J. Brown ◽  
N.D. Fleming ◽  
A.M. Nick ◽  
P.T. Soliman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cervical Cytology ◽  
Prior History ◽  
Radical Trachelectomy ◽  
History Of
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