scholarly journals Rupatadine to prevent local allergic reactions to sublingual allergy immunotherapy: a case series

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Anne K. Ellis ◽  
Lori Connors ◽  
Marie-Josee Francoeur ◽  
Douglas P. Mack
Keyword(s):  
Allergic Rhinitis ◽  
Platelet Activating Factor ◽  
Case Series ◽  
Clinical Trial Data ◽  
House Dust Mites ◽  
Allergic Reactions ◽  
H1 Antihistamines ◽  
History Of ◽  
Case Presentations ◽  
Patients Experience

Abstract Background Sublingual immunotherapy tablets (SLIT-T) are an effective treatment for allergic rhinitis (AR), but some patients experience local allergic reactions (LAR) in the first few weeks of treatment that can lead to treatment discontinuation. Although oral antihistamines are recommended for the treatment and pretreatment of LAR associated with SLIT-T, there are no clinical trial data to support this recommendation. Rupatadine is an H1 antihistamine that also inhibits platelet activating factor activity. The objective of this case series is to describe real-world clinical situations in which rupatadine was used to treat or mitigate SLIT-T–related LAR. Case presentations Five cases are presented by the managing allergist and off-label use of rupatadine is their expert opinion only. Patients in all 5 cases were treated with a SLIT-T (e.g. ragweed, tree, grass, or house dust mites) for the management of allergic rhinitis and experienced bothersome LAR with the first SLIT-T administration. In 3 cases, rupatadine 10 mg was administered for the immediate treatment of LAR (either in-office with the first SLIT-T dose or for subsequent LAR experienced at home) and the symptoms resolved. In 3 cases, pretreatment with other second-generation H1 antihistamines was unable to prevent LAR and the patients discontinued the SLIT-T. In these 3 cases, switching to pretreatment with rupatadine allowed the patients to restart and tolerate SLIT-T treatment with minimal or no LAR. In these patients with an established history of LAR, proactive pretreatment with rupatadine in subsequent seasons or with initiation of a different SLIT-T mitigated the previously experienced LARs. Conclusions In the cases presented, treatment with rupatadine resolved LAR associated with SLIT-T treatment and rupatadine pretreatment appeared to mitigate subsequent LAR. Rupatadine may be an option to treat or improve the tolerability of the SLIT-T, potentially improving early treatment persistence.

New perspectives on propofol allergy

2021 ◽  
Author(s):  
Jessica L Johnson ◽  
Ashley Hawthorne ◽  
Michael Bounds ◽  
David J Weldon
Keyword(s):  
Alternative Therapy ◽  
Clinical Trial Data ◽  
Cross Reactivity ◽  
Food Allergies ◽  
Critical Examination ◽  
Evidence Based ◽  
Allergic Reactions ◽  
Definitive Evidence ◽  
Medication Costs ◽  
History Of

Abstract Purpose Propofol is an intravenous sedative used in many patient populations and care settings. Although generally considered safe and effective, the drug has historically been avoided in patients with reported allergies to egg, soy, and/or peanut on the basis of the manufacturer’s prescribing information. Concerns exist for potential adverse events, increased medication costs, reduced efficacy, and risk of medication errors when using alternative agents. Here we present a critical examination of the literature concerning cross-reactivity of food allergies with propofol to provide evidence-based recommendations for the evaluation and management of potential allergic reactions. Summary Literature regarding the history of propofol allergy warnings and clinical trial data were assessed to provide an alternative perspective on avoidance of propofol in patients with food allergies. Suspected trigger molecules are discussed with evaluation of the antigenic potential of excipient ingredients used in the manufacture of multiple propofol formulations. Evidence-based recommendations are provided for pharmacist-led screening of adult patients with reported food allergies to support selection of propofol or alternative therapy. Conclusion There is a lack of definitive evidence that propofol must be routinely avoided in patients with reported allergies to egg, soy, and/or peanut products. Data from clinical trials suggest that propofol is safe for patients with nonanaphylactic food allergies. Patients who do experience allergic reactions following administration of propofol should undergo further testing to definitively identify the specific trigger and prevent future unnecessary avoidance of preferred medication regimens. Pharmacists can play an important role in interviewing patients with reported food allergies to better determine the risk vs benefit of propofol avoidance.

scholarly journals ALLERGIC RHINITIS IN PRE-SCHOOL CHILDREN LIVING IN URBAN SETTINGS OF THE ALTAI REGION: A POPULATION-BASED CROSS-SECTIONAL STUDY

2018 ◽  
Vol 17 (3) ◽  
pp. 236-243
Author(s):  
Natalia V. Shakhova ◽  
Elena M. Kamaltynova ◽  
Yuriy Ph. Lobanov ◽  
Tatyana S. Ardatova
Keyword(s):  
Risk Factors ◽  
Allergic Rhinitis ◽  
Atopic Dermatitis ◽  
Family History ◽  
School Children ◽  
Vitamin D3 ◽  
House Dust Mites ◽  
Urban Settings ◽  
Altai Region ◽  
History Of

Background.It is necessary to study the prevalence and risk factors of allergic rhinitis (AR) among pre-school children in order to develop a disease prevention strategy.Objective.Our aim was to study the prevalence, clinical and allergological features, and risk factors for AR in pre-school children living in urban settings of the Altai Region.Methods.At the screening stage, the study enrolled children aged 3–6 years attending pre-school educational institutions in 5 cities of the Altai Region. AR symptoms were determined using the ISAAC questionnaire. The AR was diagnosed if ≥ 2 symptoms (rhinorrhea, nasal breathing difficulty, itching in the nasal cavity, repetitive sneezing) lasted ≥ 1 h with a positive prick test and/or a blood level of specific IgE > 0.35 kU/L to at least one allergen (total 11).Results.The prevalence of AR in urban children aged 3–6 years (n = 3,205) was 10.6%; 48% of them were previously diagnosed with AR. 85% of children had a persistent course of the disease; 69% had mild AR. Most often, there was established sensitization to house dust mites (61.6%), birch pollen (40.9%), and cat fur (19.4%). The risk factors for AR were family history of allergies [odds ratio (OR) 4.2; 95% confidence interval (CI) 3.5–5.9], masculine (OR 2.8, 95% CI 1.9–4.0), smoking parents (OR 1.8, 95% CI 1.2–2.9), nonadherence to a regimen/dosage of vitamin D3 intake in infancy (OR 1.8, 95% CI 1.2–2.8), presence of asthma-like symptoms (OR 10.2, 95% CI 7.2–14.5), and manifestations of atopic dermatitis (OR 6.0, 95% CI 4.2–8.5).Conclusion.AR occurs in every tenth pre-school child (mainly of mild severity and persistent course), every second disease among them was diagnosed for the first time. Sensitization occurs to typical for childhood allergens. The risk factors for AR are family history of allergies, masculine, passive smoking, ignoring the recommendations of taking vitamin D3 in infancy, the presence of atopic dermatitis, and asthma-like symptoms.

scholarly journals CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for the treatment of allergic rhinitis and urticaria

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Michael N. Fein ◽  
David A. Fischer ◽  
Andrew W. O’Keefe ◽  
Gord L. Sussman
Keyword(s):  
Allergic Rhinitis ◽  
Chronic Urticaria ◽  
First Generation ◽  
Position Statement ◽  
Poor Sleep ◽  
Third Generation ◽  
First Line ◽  
H1 Antihistamines ◽  
History Of ◽  
History Of Use

Abstract Oral H1-antihistamines (AHs) are the most commonly used therapy to treat allergic rhinitis and chronic urticaria. Older, first-generation AHs (e.g. diphenhydramine, hydroxyzine) have significant and common side effects including sedation, impairment with decreased cognitive function, poor sleep quality, dry mouth, dizziness, and orthostatic hypotension. These drugs have also been found to result in death from accidents, intentional or unintentional overdoses, and sudden cardiac death. The unfavourable risk–benefit profile of first-generation AHs led to the development of newer, less-sedating second- and third-generation AHs, which first became available in Canada in the 1980s. High-quality trials have proven that newer generation AHs are superior in safety compared to older first-generation AHs. On average, they have improved potency and efficacy. Second- and third-generation AHs are the recommended first-line treatment for mild allergic rhinitis and acute and chronic urticaria. Despite this evidence, older first-generation AHs continue to be over-utilized because of their over-the-counter (OTC) status and long history of use. The Canadian Society of Allergy Clinical Immunology (CSACI) recommends that newer generation AHs should be preferred over first-generation AHs for the treatment of allergic rhino-conjunctivitis and urticaria. To promote this recommendation, education of health professionals and the public is necessary. Further, given the dangers of older first-generation AHs, we believe they should be used only as a last resort with eventual consideration given to having them only available behind the counter in pharmacies.

H1 Antihistamines’ effect on pro-inflammatory Cytokines in allergic rhinitis to house dust mites

2015 ◽  
Vol 37 (8) ◽  
pp. e106-e107
Author(s):  
I.C. Bocsan ◽  
I.A. Muntean ◽  
S. Vesa ◽  
D. Deleanu ◽  
A.D. Buzoianu
Keyword(s):  
Allergic Rhinitis ◽  
Inflammatory Cytokines ◽  
House Dust ◽  
House Dust Mites ◽  
Dust Mites ◽  
H1 Antihistamines ◽  
Pro Inflammatory Cytokines

scholarly journals Effect of Fluticasone propionate Aqueous Nasal Spray Treatment on Platelet Activating Factor and Eicosanoid Production By nasal Mucosa in Patients with A house Dust Mite Allergy

1994 ◽  
Vol 3 (5) ◽  
pp. 381-385 ◽  
Author(s):  
I. M. Garrelds ◽  
T. de Graaf-in 't Veld ◽  
A. P. H. Jansen ◽  
R. Gerth van Wijk ◽  
F. J. Zijlstra
Keyword(s):  
Fluticasone Propionate ◽  
Nasal Spray ◽  
Nasal Mucosa ◽  
House Dust ◽  
House Dust Mite ◽  
Platelet Activating Factor ◽  
House Dust Mites ◽  
Allergic Reactions ◽  
Dust Mite ◽  
Allergen Provocation

The relationship between the release of platelet activating factor (PAF), leukotriene C4/D4/EE(LTC4/D4/E4) and prostaglandin D2(PGD2) from nasal mucosain vivowas examined in 24 rhinitis patients allergic to the house dust mite (HDM). During a double blind placebo controlled cross-over study 200 μg fluticasone propionate aqueous nasal spray (FPANS) was administered twice daily for two weeks. In response to allergen provocation (100, 1 000, 10 000 Bu/ml) and during the 9.5 h after this challenge the nasal fluid was obtained by washing the nose with saline and the levels of PAF, LTC4/D4/E4and PGD2, as indicators of mediator release, were measured at the following time-points: baseline (t = − 1/2), allergen provocation with 10 000 Bu/ml (t = 0), 3.5 and 7.5 h (late phase). After allergen provocation the levels of the mediators increased in the nasal fluids of placebo treated patients (x-fold increase to baseline: PAF, 15; LTC4/D4/E4, 12; PGD2, 1.5). In fluids of patients treated with FPANS these levels tended to decrease. At the time of provocation the levels of PAF, LTC4/D4/E4and PGD2showed a significant correlation. The results indicate that these mediators can be used as markers of allergic reactions against house dust mites and that fluticasone propionate aqueous nasal spray tended to reduce the release of mediators of inflammation correlated with beneficial effects on clinical symptoms in this type of allergic reactions.

Sequential degranulation of eosinophils induced by antigen or autocoids in allergic humans

1986 ◽  
Vol 44 ◽  
pp. 354-355
Author(s):  
Kate W. Sjoerdsma ◽  
W. James Metzger
Keyword(s):  
Allergic Rhinitis ◽  
Bronchoalveolar Lavage ◽  
Allergic Asthma ◽  
Skin Test ◽  
Positive Skin Test ◽  
Positive Skin ◽  
Human Eosinophil ◽  
Asthmatic Patients ◽  
Allergic Asthmatic ◽  
History Of

Eosinophils are important to the pathogenesis of allergic asthma, and are increased in bronchoalveolar lavage within four hours after bronchoprovocation of allergic asthmatic patients, and remain significantly increased up to 24 hours later. While the components of human eosinophil granules have been recently isolated and purified, the mechanisms of degranulation have yet to be elucidated.We obtained blood from two volunteers who had a history of allergic rhinitis and asthma and a positive skin test (5x5mm wheal) to Alternaria and Ragweed. Eosinophils were obtained using a modification of the method described by Roberts and Gallin.

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

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