scholarly journals Methylprednisolone-induced anaphylaxis diagnosed by intradermal skin test: a case report

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Hitomi Amano ◽  
Yoshiro Kitagawa ◽  
Tomohito Hayakawa ◽  
Taichiro Muto ◽  
Akihisa Okumura ◽  
...  
Keyword(s):  
Skin Test ◽  
Sodium Phosphate ◽  
Case Reports ◽  
Sodium Succinate ◽  
Oral Prednisolone ◽  
Basophil Activation Test ◽  
Pulse Therapy ◽  
Prick Test

Abstract Background Glucocorticoids rarely cause anaphylaxis. Common methods for the determination of allergens include in vivo skin prick test (SPT) and intradermal skin test (IDST) and the in vitro basophil activation test (BAT). However, to our knowledge, the best strategy for diagnosing glucocorticoid-induced anaphylaxis has not been elucidated. Case presentation A 10-year-old boy was admitted to our hospital because of 2 weeks of fever and arthralgia. He had not been treated with glucocorticoids before, including methylprednisolone (mPSL). He was suspected to have bacterial myositis and was treated with ceftriaxone. However, his symptoms persisted for > 2 weeks. Autoinflammatory arthritis was suspected, and he was treated with mPSL sodium succinate (MPS) pulse therapy (30 mg/kg). After 15 min of mPSL injection, he had wheezing and generalized wheal formation with decreased oxygen saturation. As anaphylaxis was suspected, mPSL was discontinued, and olopatadine and oxygen were administered. The symptoms improved considerably without the use of epinephrine and disappeared in 30 min. One month after discharge, SPT, IDST, and BAT were performed without discontinuing his prescribed oral prednisolone. SPTs for MPS, hydrocortisone sodium succinate (HCS), prednisolone sodium succinate (PSS), dexamethasone sodium phosphate (DSP), and betamethasone sodium phosphate (BSP) were negative. IDSTs for MPS, HCS, and PSS were positive, whereas those for DSP and BSP were negative. By contrast, BATs for MPS, HCS, and PSS were negative. Although glucocorticoid-induced hypersensitivity caused by nonmedicinal ingredients such as lactose, carboxymethylcellulose, polyethylene glycol, and hexylene glycol has been reported; the glucocorticoids tested in this patient did not contain any of these nonmedicinal ingredients. As the glucocorticoids that were positive on IDST share a succinate ester, this might have caused MPS-induced anaphylaxis. Conclusions We report the case of MPS-induced anaphylaxis diagnosed by IDST but not BAT. In case reports of glucocorticoid-induced anaphylaxis in the literature, most patients were diagnosed with SPT or IDST. These results suggest that BAT should be considered when IDST and SPT are negative. Further studies are necessary to clarify the best strategy for diagnosing glucocorticoid-induced anaphylaxis.

scholarly journals Methylprednisolone-induced Anaphylaxis Diagnosed by Intradermal Skin Test Not Basophil Activation Test: A Case Report

2020 ◽  
Author(s):  
Hitomi Amano ◽  
Yoshiro Kitagawa ◽  
Taichiro Muto ◽  
Akihisa Okumura ◽  
Hideyuki Iwayama
Keyword(s):  
Skin Test ◽  
Incubation Time ◽  
Sodium Phosphate ◽  
Sodium Succinate ◽  
Basophil Activation Test ◽  
Basophil Activation ◽  
Diagnostic Strategy ◽  
Activation Test

Abstract BackgroundAnaphylaxis is a severe systemic allergic reaction. Glucocorticoids rarely induce anaphylaxis. Determination of allergens includes the in vivo skin prick test (SPT) and intradermal skin test (IDST) and the in vitro basophil activation test (BAT). However, the usefulness of BAT in determining drug allergens has not been adequately studied.Case presentation A 10-year-old boy was admitted to our hospital because of fever and arthralgia for 2 weeks. He had not been treated with glucocorticoids. According to the laboratory tests and imaging studies, he was suspected to have bacterial myositis and was treated with ceftriaxone. However, his symptoms persisted for more than 2 weeks. With a suspicion of autoinflammatory arthritis, we planned methylprednisolone (mPSL) sodium succinate (MPS) during pulse therapy (30 mg/kg). Fifteen minutes after the injection of mPSL, he had wheezing and generalized wheal formation with decreased oxygenation. The administration of mPSL was discontinued because anaphylaxis was suspected. Thirty minutes after the administration of oxygen and oral olopatadine, the anaphylactic symptoms resolved. One month after discharge, SPT, IDST, and BAT were performed under the administration of oral prednisolone. The SPTs for MPS, hydrocortisone sodium succinate (HCS) and prednisolone sodium succinate (PSS) were negative. The IDST for MPS was positive. Moreover, the IDSTs for HCS and PSS were positive, whereas those for dexamethasone sodium phosphate and betamethasone sodium phosphate were negative. The BAT for MPS was negative at 1.0% and 1.9% after an incubation time of 1 hour and 24 hours, respectively, although the BAT for histamine as positive control was 60.4% and 18.3% after an incubation time of 1 hour and 24 hours, respectively. The BATs for HCS and PSS were negative. Therefore, we diagnosed as anaphylaxis secondary to the succinate ester in MPS.ConclusionsIn this case, IDST was useful for the diagnosis of MPS-induced anaphylaxis, whereas BAT was negative. This highlighted the need to choose the appropriate procedure in the diagnosis of steroid-induced anaphylaxis. The results in our patient suggested that BAT may be considered when IDST and SPT are negative. Further studies are necessary to clarify the diagnostic strategy for steroid-induced anaphylaxis.

scholarly journals Approaches to the Management of Presumed Immediate Hymenoptera Venom Allergy and Non-Detectable IgE

2010 ◽  
Vol 3 (1) ◽  
pp. 16-23
Author(s):  
Ervin Ç. Mingomataj ◽  
Alketa H. Bakiri
Keyword(s):  
Skin Test ◽  
Case Reports ◽  
Skin Tests ◽  
Diagnostic Tools ◽  
In Vitro Tests ◽  
Insect Allergy ◽  
History Of ◽  
Cellular Tests

Objective: To provide a comprehensive evaluation in patients with a convincing history of immediate insect allergy but negative skin test and/or specific IgE results, adequately addressing the question of how best to manage them. Data sources: Observational peer-reviewed studies and case reports were searched on Pub-Med database from 1998 up to March 2009 using the following keywords: Hymenoptera Allergy & Negative IgE (Negative Skin Tests). Study selection: Studies on supplemental diagnostic tests that provided data from patients with immediate hymenoptera allergy but negative conventional tests results to the offending allergens were selected. In this work, we also included studies providing additional relevant information regarding this issue. Results: Among 43 identified papers only 9 of them presented relevant original data, while the other papers were reviews. In the majority of the cases, the culprit insect was identified with in vitro tests such as Basophil Activation Test, Cellular Allergen Stimulation Test or Western blot, whereas in vivo (less frequently) with sting challenge or dialyzed venom skin test. Conclusions: The management of patients with a convincing history of immediate insect allergy but negative conventional test results requires an adaption of the guidelines including an incorporation of the novel diagnostic tools. Although cellular tests represent equivalent sensitivity and superior specificity as compared with standard ones, these tests still remain supplementary diagnostic tools. In a minority of cases (especially in the developing countries where cellular tests cannot be performed), venom immunotherapy in adult subjects could be taken into account based solemnly on the history of a clear patient’s identification of the culprit insect.

Oral Terbinafine: A New Antifungal Agent

1997 ◽  
Vol 31 (4) ◽  
pp. 445-456 ◽  
Author(s):  
Susan M Abdel-Rahman ◽  
Milap C Nahata
Keyword(s):  
Adverse Effects ◽  
Drug Interactions ◽  
Fungal Infections ◽  
Case Reports ◽  
Current Standard ◽  
Open Label ◽  
Double Blind ◽  
Pathogenic Yeast

Objective To review the pharmacology, pharmacokinetics, efficacy, adverse effects, drug interactions, and dosage guidelines of terbinafine. Available comparative data of terbinafine and other antimycotic agents are described for understanding the potential role of terbinafine in patient care. Data Sources A MEDLINE search restricted to English language during 1966–1996 and extensive review of journals was conducted to prepare this article. MeSH headings included allylamines, terbinafine, SF 86–327, dermatophytosis, dermatomycosis. Data Extraction The data on pharmacokinetics, adverse effects, and drug interactions were obtained from open-label and controlled studies and case reports. Controlled single- or double-blind studies were evaluated to describe the efficacy of terbinafine in the treatment of various fungal infections. Data Synthesis Terbinafine is the first oral antimycotic in the allylamines class: a fungicidal agent that inhibits ergosterol synthesis at the stage of squalene epoxidation. Terbinafine demonstrates excellent in vitro activity against the majority of dermatophyte species including Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum; less activity is seen against Dematiaceae and the filamentous fungi. It is least active against the pathogenic yeast and this correlates with the relatively poor efficacy against these organisms in vivo. High concentrations of terbinafine are achieved in keratinous tissues, the site of superficial infections, and these concentrations are maintained for up to 3 months. The clinical efficacy of terbinafine against a number of dermatophyte infections exceeds that of the current standard of therapy, griseofulvin. The efficacy of terbinafine may be as good or better than that of the azole antifungals. Additional studies are required to confirm these observations. Terbinafine demonstrates a good safety profile, and relatively few drug interactions have been identified. Conclusions Terbinafine is more effective than the gold standard, griseofulvin, in the treatment of tinea pedis and tinea unguinum, with considerably shorter treatment duration in the latter. It has been proven as effective as griseofulvin in the treatment of tinea capitis, tinea corporis, and tinea cruris. Terbinafine does not appear to offer any advantage in the treatment of nondermatophyte infections; its utility in the treatment of systemic infections has yet to be established. Depending on individual institutional costs, terbinafine may be a front-line drug for some superficial infections responding poorly to the current standard of therapy.

scholarly journals Development of a Human Gamma Interferon Enzyme Immunoassay and Comparison with Tuberculin Skin Testing for Detection ofMycobacterium tuberculosis Infection

1998 ◽  
Vol 5 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Nuket Desem ◽  
Stephen L. Jones
Keyword(s):  
Enzyme Immunoassay ◽  
Skin Test ◽  
Skin Testing ◽  
Gamma Interferon ◽  
Tuberculin Skin Testing ◽  
In Vitro Test ◽  
Detection Range ◽  
Ifn Γ

ABSTRACT A sensitive two-step simultaneous enzyme immunoassay (EIA) for human gamma interferon (IFN-γ) has been developed and used as an in vitro test for human tuberculosis (TB) in comparison with tuberculin skin testing. The EIA was shown to be highly sensitive, detecting less than 0.5 IU of recombinant human IFN-γ per ml within a linear detection range of 0.5 to 150 IU/ml. The assay was highly reproducible and specific for native IFN-γ. In addition, the assay detected chimpanzee, orangutan, gibbon, and squirrel monkey IFN-γs. Cross-reactions with other human cytokines or with IFN-γs derived from mice, cattle, or Old World monkeys were not evident. The assay was used to detect TB infection by incubating whole blood overnight with human, avian, and bovine tuberculin purified protein derivatives (PPDs), as well as positive (mitogen)- and negative-control preparations. The levels of IFN-γ in plasma supernatants were then determined. Blood from 10 tuberculin skin test-positive individuals responded predominantly to the human tuberculin PPD antigen and to a lesser extent to bovine and avian PPD antigens. By contrast, blood from 10 skin test-negative individuals showed minimal responses or no response to any of the tuberculin PPDs. Detectable levels of IFN-γ were present in all blood samples stimulated with mitogen. In vivo tuberculin reactivity was correlated with IFN-γ responsiveness in vitro. These results support the further study of the blood culture–IFN-γ EIA system as an alternative to skin testing for the detection of human TB infection.

scholarly journals Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

2019 ◽  
Vol 7 (4) ◽  
pp. 141-168 ◽  
Author(s):  
Emad Alsarraf ◽  
Jamie Myers ◽  
Sarah Culbreth ◽  
John Fanikos
Keyword(s):  
Adverse Events ◽  
Case Reports ◽  
In Vivo Studies ◽  
Poison Control ◽  
Cross Sectional ◽  
Randomized Controlled ◽  
Reversible Encephalopathy ◽  
Neonatal Withdrawal

Abstract Purpose of Review This review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal. Recent Findings Multiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute and chronic physiological and psychological adverse events. Summary Reports of adverse effects associated with kratom use have demonstrated hypothyroidism, hypogonadism, hepatitis, acute respiratory distress syndrome, posterior reversible encephalopathy syndrome, seizure, and coma. Overdose toxidrome leads to respiratory failure, cardiac arrest, and fatalities. Adult and neonatal withdrawal symptoms have also occurred. Clinicians should be aware of the risks and benefits of kratom use.

Zirconia Biocompatibility in Animal Studies - A Systematic Review

2017 ◽  
Vol 376 ◽  
pp. 12-28 ◽  
Author(s):  
Sanda Mihaela Popescu ◽  
Horia Octavian Manolea ◽  
Oana Andreea Diaconu ◽  
Veronica Mercuţ ◽  
Monica Scrieciu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dental Implants ◽  
Animal Studies ◽  
Case Reports ◽  
Powder Injection ◽  
Mesh Terms ◽  
Meta Analyses ◽  
Abstract Screening

Zirconia is a metal used in dental implantology. Its biocompatibility was studied in vitro and in vivo, results of the studies being analyzed in reviews and meta analyses. The aim of this systematic review was to evaluate biocompatibility of zirconia in animal studies in vivo expressed as results of histomorphometric tests. Databases were searched from 1980 until February 2016, with different combination of the following MeSH terms: zirconium, biocompatibility, dental implants, in vivo, animal studies. Letters to the editors, case reports, commentaries, review articles and articles published in other languages then English were excluded. The search of PubMed, ScienceDirect and Google Scholar databases yielded 690 titles. After abstract screening and duplicate discarding 50 articles were identified and finally, 40 were included in the review. Most of the studies compared zirconia with titanium, a well established material for dental implants. In majority of the studies zirconia showed a similar osseointegration with titanium. Surface implant treatments, like sandblasted and etched zirconia (ZrO2-SLA), alumina toughed zirconia (ATZ), and powder injection molding (PIM) were used to improve osseointegration of zirconia with good results. In the light of histomorphometric test, zirconia, no matter physical and structural forms tested, is a biocompatible material.

The Effect of Methylprednisolone Sodium Succinate on Erythrocyte and Haemoglobin Function

1980 ◽  
Vol 59 (3) ◽  
pp. 163-168 ◽  
Author(s):  
M. Brada ◽  
L. A. Robinson ◽  
A. J. Bellingham
Keyword(s):  
Whole Blood ◽  
Sodium Succinate ◽  
Oxygen Affinity ◽  
Whole Cells ◽  
Methylprednisolone Sodium Succinate ◽  
Acid Citrate Dextrose ◽  
Citrate Dextrose ◽  
Therapeutic Doses

1. As it has been suggested that the beneficial effect of methylprednisolone in shock is due to its effect on erythrocyte oxygen affinity, we studied its effect on incubated erythrocytes and on haemoglobin solution. 2. Incubation of fresh whole blood anticoagulated with acid/citrate/dextrose with methylprednisolone (7 mmol/l) produced a significant decrease in oxygen affinity, which was not seen with lower concentrations of methylprednisolone. When either acid/citrate/dextrose blood stored for 10 days or fresh heparinized blood was used, no significant increase in the partial pressure of oxygen at 50% haemoglobin saturation (P50) was demonstrated even with methylprednisolone at 7 mmol/l. At the highest concentration achieved in plasma with standard therapeutic doses (56 μmol/l) there was no increase in P50 under all the conditions studied. 3. Methylprednisolone reduced the oxygen affinity of haemoglobin in solution. The reduction in oxygen affinity was less than that produced by 2,3-diphosphoglycerate and more than that of either sodium succinate or sodium chloride. 4. From the results of this study we conclude that the effect observed in whole cells is probably due to a direct effect of methylprednisolone on haemoglobin. To produce a significant decrease of oxygen affinity of whole blood in vitro requires a plasma concentration of methylprednisolone above that obtained in plasma in vivo, with the currently used therapeutic doses.

scholarly journals Optimizing a Protocol to Assess Immune Responses after SARS-CoV-2 Vaccination in Kidney-Transplanted Patients: In Vivo DTH Cutaneous Test as the Initial Screening Method

Vaccines ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1315
Author(s):  
Yvelise Barrios ◽  
Aurelio Rodriguez ◽  
Andrés Franco ◽  
Cristina Alava-Cruz ◽  
Domingo Marrero-Miranda ◽  
...  
Keyword(s):  
Immune Response ◽  
T Cell ◽  
Skin Test ◽  
Natural Infection ◽  
Screening Method ◽  
Delayed Type Hypersensitivity ◽  
Interferon Gamma Release Assay ◽  
Cutaneous Test

Previously, the delayed-type hypersensitivity (DTH) cutaneous test with the spike protein of SARS-CoV-2 has been shown to be a simple in vivo method to measure T-cell functionality after natural infection and in vaccinated individuals. Methods: Twenty-five kidney-transplanted recipients were immunized with two doses of the mRNA-based Pfizer–BioNTech COVID19 vaccine three weeks apart. Cell-immune response (CIR) was evaluated ten weeks later using an in vivo DTH skin test and in vitro with an interferon gamma release assay (IGRA). Humoral Immune Response (HIR) was determined by the measurement of specific IgG anti-S1 SARS-CoV-2. Results: Ten weeks after the second dose of the vaccine, 23 out of 25 transplanted patients had a positive DTH skin test, while in vitro CIR was considered positive in 20 patients. Unspecific stimulation was positive in all 25 patients, showing no T-cell defect. Seven out of twenty-five patients had a negative specific anti-spike IgG. CIR was positive in all immune-competent control patients. Conclusions: DTH is a useful, simple, and cheaper tool that can be used to assess cellular immune response, with an excellent correlation with the in vitro CIR. CIR assessment after vaccination in these immunocompromised patients is an excellent complement to HIR-based methods. This skin test could be used if classical in vitro methods cannot be applied.

Mechanism of Action of Limonene in Tumor Cells: A Systematic Review and Metanalysis

2020 ◽  
Vol 26 ◽  
Author(s):  
Juliana de Vasconcelos Cerqueira Braz ◽  
Fernanda Oliveira de Carvalho ◽  
Daniele de Vasconcelos Cerqueira Meneses ◽  
Fernanda Araújo Felipe Calixto ◽  
Hericalizandra Santa Rosa Santana ◽  
...  
Keyword(s):  
Systematic Review ◽  
Tumor Regression ◽  
Case Reports ◽  
Meta Analysis ◽  
Public Health Problem ◽  
Major Public Health Problem ◽  
Kappa Index ◽  
Induced Apoptosis

Background: Cancer is a complex, multifactorial disease, and a major public health problem, as it is a leading cause of morbidity and mortality worldwide. Although treatments have significantly improved, there is a still a search for more effective drugs. One source for these are natural products (NPs). One NP that has shown anticancer activity is Limonene. However, the mechanisms of limonene's antiproliferative, anticancer and antineoplastic activity are not fully understood. Objective: The objective of this study is, therefore, to undertake a systematic review and meta-analysis of the literature on this subject. Methods: A comprehensive literature search was performed using the Scopus, MEDLINE-PubMed, Web of Science, and Science Direct databases using the keywords: "limonene", “cancer”, “neoplasm”, “tumor”. The inclusion criteria were: in vivo and in vitro studies on the use of limonene in cancer published in English, Portuguese and Spanish until December 2019. Review articles, meta-analyses, abstracts, conference papers, editorials/letters and case reports were excluded. Results: The search identified 3568 articles. Of which 126 were selected for full reading with 11 papers meeting the review criteria. Six more papers were added from the references of the initial 11 texts, giving a total of 17 papers. There was a high level of agreement on inclusion/exclusion (Kappa index > 80%). Risk of bias I the texts was shown to be high. Conclusion: The meta-analysis suggests that limonene acts mainly on tumor regression induced apoptosis, and is a promising natural product for use in the treatment of several types of cancer.

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