scholarly journals Predominant patterns of β-lactam hypersensitivity in a single German Allergy Center: exanthem induced by aminopenicillins, anaphylaxis by cephalosporins

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Philipp Schrüfer ◽  
Knut Brockow ◽  
Johanna Stoevesandt ◽  
Axel Trautmann
Keyword(s):  
Skin Testing ◽  
Delayed Type Hypersensitivity ◽  
Intradermal Testing ◽  
Reaction Type ◽  
Clinical Reaction ◽  
Additional Information ◽  
Lactam Antibiotic ◽  
Delayed Reactions ◽  
Ige Mediated ◽  
Almost All

Abstract Background Penicillins and other β-lactam antibiotics are the most common elicitors of allergic drug reaction. However, data on the pattern of clinical reaction types elicited by specific β-lactams are scarce and inconsistent. We aimed to determine patterns of β-latam allergy, i.e. the association of a clinical reaction type with a specific β-lactam antibiotic. Methods We retrospectively evaluated data from 800 consecutive patients with suspected β-lactam hypersensitivity over a period of 11 years in a single German Allergy Center. Results β-lactam hypersensitivity was definitely excluded in 595 patients, immediate-type (presumably IgE-mediated) hypersensitivity was diagnosed in 70 and delayed-type hypersensitivity in 135 cases. Most (59 out of 70, 84.3%) immediate-type anaphylactic reactions were induced by a limited number of cephalosporins. Delayed reactions were regularly caused by an aminopenicillin (127 out of 135, 94.1%) and usually manifested as a measles-like exanthem (117 out of 135, 86.7%). Intradermal testing proved to be the most useful method for diagnosing β-lactam allergy, but prick testing was already positive in 24 out of 70 patients with immediate-type hypersensitivity (34.3%). Patch testing in addition to intradermal testing did not provide additional information for the diagnosis of delayed-type hypersensitivity. Almost all β-lactam allergic patients tolerated at least one, usually several alternative substances out of the β-lactam group. Conclusions We identified two patterns of β-lactam hypersensitivity: aminopenicillin-induced exanthem and anaphylaxis triggered by certain cephalosporins. Intradermal skin testing was the most useful method to detect both IgE-mediated and delayed-type β-lactam hypersensitivity.

Pharmacist-driven penicillin skin testing service for adults prescribed nonpreferred antibiotics in a community hospital

2019 ◽  
Author(s):  
Ethan Englert ◽  
Andrea Weeks
Keyword(s):  
Health System ◽  
Community Hospital ◽  
Immunoglobulin E ◽  
Skin Testing ◽  
Hospital Setting ◽  
Primary Objective ◽  
Type I ◽  
Beta Lactam ◽  
Lactam Antibiotic ◽  
Ige Mediated

Abstract Purpose Results of a study evaluating the implementation and impact of a pharmacist-driven penicillin skin testing (PST) service for patients prescribed alternative antibiotics in the community hospital setting are reported. Methods A prospective pilot service in which patients with a documented penicillin allergy (type I, immunoglobulin E [IgE]–mediated) and were prescribed alternative antibiotics received PST by a trained pharmacist was implemented; if test results were negative, the allergy was de-labeled from their electronic medical record. The primary objective was the percentage of patients switched to first-line antibiotics. Secondary objectives included length of stay (LOS) and inpatient antimicrobial costs to the health system. Results Twenty-two patients were proactively identified and received PST by a pharmacist. Of those tested, all were negative, with no type I (IgE-mediated) hypersensitivity reactions to the test itself or to the beta-lactam antibiotic administered thereafter; 68.2% (15/22) were successfully transitioned to a beta-lactam after PST. As a result, a decrease in the use of fluoroquinolones and vancomycin and an increase in use of narrow penicillin-based antibiotics and first- and second-generation cephalosporins were observed. The mean ± S.D. LOS per patient was 7.41 ± 6.1 days, and the total cost of inpatient antimicrobial therapy to the health system was $1,698.88. Conclusion A pharmacist-driven PST service was successfully implemented in a community hospital setting.

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 Allergic Reaction to Mint Leads to Asthma

2011 ◽  
Vol 2 (1) ◽  
pp. ar.2011.2.0008 ◽  
Author(s):  
Anthony M. Szema ◽  
Tisha Barnett
Keyword(s):  
Contact Dermatitis ◽  
Adverse Reactions ◽  
Skin Testing ◽  
Specific Ige ◽  
Delayed Type Hypersensitivity ◽  
Contact Allergens ◽  
Multiple Alternative ◽  
Alternative Measures ◽  
Ige Mediated ◽  
Cutaneous Adverse Reactions

Respiratory and cutaneous adverse reactions to mint can result from several different mechanisms including IgE-mediated hypersensitivity, delayed-type hypersensitivity (contact dermatitis), and nonimmunologic histamine release. Reactions to cross-reacting plants of the Labiatae family, such as oregano and thyme, as well as to the chemical turpentine, may clue the clinician in on the diagnosis of mint allergy. Contact dermatitis can result from menthol in peppermint. Contact allergens have been reported in toothpastes, which often are mint-flavored. Allergic asthma from mint is less well-recognized. A case of a 54-year-old woman with dyspnea on exposure to the scent of peppermint is presented in whom mint exposure, as seemingly innocuous as the breath of others who had consumed Tic Tac candies, exacerbated her underlying asthma. This case highlights the importance of testing with multiple alternative measures of specific IgE to mint, including skin testing with mint extract, and skin testing with fresh mint leaves. Additionally, this cases suggests that asthma can result from inhaling the scent of mint and gives consideration to obtaining confirmatory pre- and postexposure pulmonary function data by both impulse oscillometry and spirometry.

scholarly journals 162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kendall J Tucker ◽  
YoungYoon Ham ◽  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Ellie Sukerman ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
First Line ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Oral Amoxicillin ◽  
Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions &lt; 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction &gt; 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

scholarly journals Kendala Implementasi Pembelajaran Daring Pendidikan Agama Hindu Pada Siswa Kelas V Di SDN Pandawei-1

2020 ◽  
Vol 3 (3a) ◽  
Author(s):  
Lasmini
Keyword(s):  
Qualitative Research ◽  
Online Learning ◽  
Learning System ◽  
Additional Information ◽  
Corona Virus ◽  
Analysis Technique ◽  
The World ◽  
Qualitative Descriptive ◽  
Almost All ◽  
The Impact

Corona virus or covid 19 is a dangerous virus that attacks the human respiratory system. Corona virus able to change the order of almost all of life’s joints in the world of education. In order to break the chain of the covid 19, goverments introduce a pattern of long range learning by means online learning. Application of this learning model certainly brings its own impact to students. The puspose of this study is to know the impact students are experiencing class 5 country primary school Pandawei during the online learning system. The method used was qualitative research methods with data collection techniques thrugh interviews and observations. The analysis technique used is qualitative descriptive. The main find of this research is increased students study habits using this online learning methods because the students are becoming accustomed  with technology so they’re easier discovering additional information about the lesson materials received search school.

Egg Hypersensitivity and Measles-Mumps-Rubella Vaccine Administration

PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 913-917
Author(s):  
Suzanne A. Beck ◽  
Larry W. Williams ◽  
M. Annette Shirrell ◽  
A. Wesley Burks
Keyword(s):  
Atopic Dermatitis ◽  
Skin Prick Testing ◽  
Skin Testing ◽  
Screening Method ◽  
Negative Control ◽  
Mmr Vaccine ◽  
Double Blind ◽  
Intradermal Testing ◽  
Vaccine Administration ◽  
History Of

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg. Ten of these children received the MMR vaccine prior to the time that their egg sensitivity was elucidated. Two other children were vaccinated elsewhere after they were documented egg sensitive. All 12 of these children tolerated the vaccine without incident. These results further substantiate the safety of MMR administration in egg-sensitive children and support routine vaccination of children who do not exhibit systemic allergic hypersensitivity to egg. It is suggested that SPT is an adequate screening method for children with anaphylactic egg sensitivity.

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.

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