Skin and in vitro tests reduce the need for drug provocation tests in drug hypersensitivity to betalactams

OBJECTIVE: To report a patient with an anaphylactic reaction related to povidone administration. CASE SUMMARY: A 37-year-old man with a history of allergic rhinitis presented with urticaria, dyspnea, wheezing, rhinorrhea, and dysphonia 20 minutes after the intraarticular administration of mepivacaine hydrochloride and paramethasone acetate in his right knee. Two months after this episode, he was admitted for controlled provocation tests. Tests on mepivacaine were negative. The preparation of paramethasone contained the excipients benzalkonium chloride, polysorbate 80, and povidone. In vitro tests and provocation were negative with polysorbate 80 and benzalkonium chloride, but positive with povidone. DISCUSSION: Povidone, a mixture of synthetic polymers, is commonly used as an excipient in pharmaceutical products, an additive in food products, and a dispersant and stabilizer in hairsprays. Although it is well tolerated when used topically or parenterally, local and systemic effects have been reported. Furthermore, multiorgan involvement resulting from accumulation of the drug in the reticuloendothelial system has been described. The immunologic properties of povidone have not been explored in humans, but have been in animals. In fact, the capacity of povidone to release histamine and its immunogenicity are proportional to its molecular weight. An immunoglobulin (Ig) E-mediated hypersensitivity reaction in asthma has been reported. In our case, povidone was responsible for the syndrome. However, we cannot determine the exact mechanism. An unspecific histamine release and/or an IgE-mediated hypersensitivity could be involved. CONCLUSIONS: Povidone was responsible for a severe anaphylactic reaction in our patient. The possibility of an iatrogenic adverse effect caused by the excipient but not by the active ingredient should be considered in patients exhibiting similar symptoms. We believe that the excipients used in the preparation of all medicines should be disclosed.

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Multiple drug hypersensitivity syndrome (MDH) should not be diagnosed by drug provocation tests

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2019.10.050 ◽

2020 ◽

Vol 8 (2) ◽

pp. 822-823 ◽

Cited By ~ 2

Author(s):

Lukas Jörg ◽

Daniel Yerly ◽

Werner Pichler

Keyword(s):

Drug Hypersensitivity ◽

Hypersensitivity Syndrome ◽

Multiple Drug ◽

Provocation Tests ◽

Drug Hypersensitivity Syndrome ◽

Drug Provocation Tests

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Drug Provocation Tests in Patients with a History Suggesting an Immediate Drug Hypersensitivity Reaction

Annals of Internal Medicine ◽

10.7326/0003-4819-140-12-200406150-00009 ◽

2004 ◽

Vol 140 (12) ◽

pp. 1001 ◽

Cited By ~ 196

Author(s):

Djamel Messaad ◽

Hocine Sahla ◽

Said Benahmed ◽

Philippe Godard ◽

Jean Bousquet ◽

...

Keyword(s):

Hypersensitivity Reaction ◽

Drug Hypersensitivity ◽

Provocation Tests ◽

Drug Hypersensitivity Reaction ◽

Drug Provocation Tests

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Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions

Romanian Neurosurgery ◽

10.33962/roneuro-2019-066 ◽

2019 ◽

pp. 411-416

Author(s):

Andrei Gheorghe Vicovan ◽

Liliana Veres ◽

Andrei Cucu ◽

Dana Turliuc ◽

Cristina Mihaela Ghiciuc

Keyword(s):

Drug Hypersensitivity ◽

Clinical Manifestations ◽

Clinical Analysis ◽

In Vitro Tests ◽

Hypersensitivity Reactions ◽

Immunological Mechanism ◽

Immunological Mechanisms ◽

Inflammatory Drugs ◽

Anti Inflammatory

The role of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in neurosurgical practice is a secondary one, however they are still constantly involved in perioperative management of pain or in nonoperative management of acute radiculopathy. Beside the well-known adverse reactions (ADRs), the neurosurgeon practitioner should also take in account the drug hypersensitivity reactions (DHRs) of NSAIDs and be able to deal with it. The aim of this paper was to review the diagnostic and management steps for NSAIDs-induced Hypersensitivity Reactions. The actual stratification of NSAIDs-induced Hypersensitivity Reactions is based on understanding of the heterogeneity of immunological/non-immunological mechanisms of reactions and complexity of clinical manifestations. Practically, this stratification allows the physician to assess suspicion of DHR, based on anamnesis and clinical analysis, and to consider further practical steps to manage and eventually confirm the diagnosis. Drug allergies are considered only the DHRs for which a definite immunological mechanism (either drug-specific antibody or T cell) is demonstrated. In conclusion, clinical analysis and anamnesis of patient with NSAIDs-induced Hypersensitivity Reactions can be realized by any physician and could be enough to diagnose, but it is not sufficient to confirm the diagnosis. In vitro tests and oral provocation challenges may be necessary to be undertaken by an allergy specialist.

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Clinical value of in vitro tests for the management of severe drug hypersensitivity reactions

Asia Pacific Allergy ◽

10.5415/apallergy.2020.10.e44 ◽

2020 ◽

Vol 10 (4) ◽

Cited By ~ 1

Author(s):

Yuttana Srinoulprasert ◽

Ticha Rerkpattanapipat ◽

Mongkhon Sompornrattanaphan ◽

Chamard Wongsa ◽

Duangjit Kanistanon

Keyword(s):

Drug Hypersensitivity ◽

In Vitro Tests ◽

Hypersensitivity Reactions ◽

Clinical Value ◽

Drug Hypersensitivity Reactions

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PATTERNS OF RESPONSE AND DRUGS INVOLVED IN HYPERSENSITIVITY REACTIONS TO BETA-LACTAMS IN CHILDREN.

10.22541/au.161635658.84094563/v1 ◽

2021 ◽

Author(s):

Isabel Torres-Rojas ◽

Diana Perez ◽

Maria Luisa Somoza-Alvarez ◽

Elisa Haroun Diaz ◽

Ana María Prieto-Moreno Pfeifer ◽

...

Keyword(s):

Clavulanic Acid ◽

Skin Testing ◽

Drug Hypersensitivity ◽

Penicillin G ◽

Hypersensitivity Reactions ◽

Beta Lactams ◽

Provocation Tests ◽

Drug Challenge ◽

Immediate Reactions

Background Beta-lactams generate different allergenic determinants that induce selective or cross-reactive drug hypersensitivity reactions (DHRs). We aimed to identify the drugs involved, the selectivity of the response, the mechanism, and the value of the different diagnostic tests for establishing a diagnosis in children evaluated for DHRs to beta-lactams. Methods Prospective study evaluating children aged under 16 years reporting DHRs to beta-lactams. Reactions were classified as immediate and nonimmediate reactions. The work-up included sIgE, skin testing and drug provocation tests (DPTs) for immediate reactions and patch testing and DPTs for nonimmediate ones. Results Of the 510 included children, 133 were evaluated for immediate reactions and confirmed in 8.3%. Skin test/in vitro IgE contributed to diagnosing half of the cases. Selective reactions occurred with amoxicillin (63%), followed by common penicillin determinants (27%) and cephalosporins (0.9%). Among nonimmediate reactions (11,4% of the 377 children evaluated), most required DPTs, 52.7% of which were positive at 6–7 days of drug challenge. Selective reactions were identified with amoxicillin (80%), penicillin G (7.5%), cephalosporins (7.5%), and clavulanic acid (5%). Urticaria and maculopapular exanthema were the most frequent entities. Conclusions There were few confirmed cases of either type of reaction. Skin testing proved less valuable in nonimmediate reactions, over half of which would also have been lost in a short DPT protocol. Selective responders to amoxicillin were more likely to have nonimmediate reactions, while clavulanic acid-selectivity was exclusive to the nonimmediate typology. Over half the cases with DPTs required 6-7 days of treatment for DHR confirmation.

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Results of Drug Provocation Tests in Patients with a History of Drug Hypersensitivity Reaction

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2012.12.1273 ◽

2013 ◽

Vol 131 (2) ◽

pp. AB171

Author(s):

Wantida Dampanrat ◽

Prapasri Kulalert ◽

Araya Yuenyongviwat ◽

Pasuree Sangsupawanich

Keyword(s):

Hypersensitivity Reaction ◽

Drug Hypersensitivity ◽

Provocation Tests ◽

Drug Hypersensitivity Reaction ◽

History Of ◽

Drug Provocation Tests

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In Vitro Research Tools in the Field of Human Immediate Drug Hypersensitivity and Their Present Use in Small Animal Veterinary Medicine

Veterinary Sciences ◽

10.3390/vetsci4010001 ◽

2016 ◽

Vol 4 (1) ◽

pp. 1 ◽

Cited By ~ 2

Author(s):

Sidonie Lavergne

Keyword(s):

Veterinary Medicine ◽

Adverse Drug Events ◽

Drug Hypersensitivity ◽

Diagnostic Tools ◽

In Vitro Tests ◽

Type I ◽

Drug Induced ◽

Validation Data ◽

Specificity And Sensitivity

Drug hypersensitivity reactions (DHR) are immune-mediated idiosyncratic adverse drug events. Type I DHR are often referred to as “immediate” and involve B lymphocyte-secreted IgE that bind to the membrane of basophils and mast cells, inducing their degranulation. This review presents various in vitro tests that were developed in the field of human type I HS and implemented as clinical diagnostic tools in human cases of immediate DHR. The respective strengths and weaknesses of each test will be discussed in parallel of validation data such as specificity and sensitivity whenever available. Some of them have also been used as diagnostic tools in veterinary medicine, but not in cases of immediate DHR. Most of these diagnostic tools can be categorized into humoral and cellular tests. The former tests measure serum concentrations of factors, such as histamine, tryptase, and drug-specific IgE. The latter assays quantify markers of drug-induced basophil activation or drug-specific lymphocyte proliferation. Pharmacogenetic markers have also been investigated in immediate DHR, but not as extensively as in non-immediate ones. Throughout, practical aspects and limitations of the tests, as well as sensitivity and specificity parameters, will be presented. In addition, the experience of veterinary medicine with these diagnostic tools will be summarized. However, to date, none of them has ever been reported in a veterinary case of type I DHR.

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