Drug allergy

Drug allergy describes clinical adverse reactions that are proved or presumed to be immunologically based. Allergic drug reactions do not resemble pharmacologic actions of the incriminated drug and may occur at fractions of what would be the therapeutic dosage. Allergic drug reactions are unpredictable; nevertheless, there is increased risk of drug hypersensitivity in (1) patients with cystic fibrosis who receive antibiotics; (2) patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) who receive trimethoprim-sulfamethoxazole or if human leukocyte antigen (HLA)-B*5701+ and receive the antiretroviral agent abacavir; (3) other genetically susceptible populations, e.g., Han-Chinese with HLA-B*1502+ who develop Stevens-Johnson syndrome and toxic epidermal necrolysis from carbamazepine, with HLA-B*5801+ who are at increased risk for such reactions from allopurinol, those with HLA-A*32:01 and receive vancomycin and develop drug reaction with eosinophilia and systemic symptoms syndrome; and (4) patients with a history of compatible allergic reactions to the same medication, similar class, or potentially unrelated medication. Specific patient groups at higher risk for drug allergy include patients with Epstein-Barr virus infection, chronic lymphatic leukemia, HIV/AIDS, cystic fibrosis, patients with seizures who are being treated with anti-epileptic medications, and patients with asthma (especially severe asthma) who are at increased risk of anaphylaxis from any cause, including drugs, compared with patients without asthma. In patients with a history of penicillin allergy, skin testing helps clarify the current level of risk for anaphylaxis by using the major (penicilloyl polylysine) and minor penicillin determinants in which sensitivity is 99%. If penicilloyl polylysine and penicillin G are used for skin testing, then the sensitivity is approximately 85‐95%. When skin test results are negative, graded challenges are performed to administer optimal or truly essential antibiotics.

Download Full-text

Effects of infectious mononucleosis and HLA-DRB1*15 in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458508100037 ◽

2009 ◽

Vol 15 (4) ◽

pp. 431-436 ◽

Cited By ~ 55

Author(s):

TR Nielsen ◽

K Rostgaard ◽

J Askling ◽

R Steffensen ◽

A Oturai ◽

...

Keyword(s):

Multiple Sclerosis ◽

Infectious Mononucleosis ◽

Human Leukocyte ◽

Epstein Barr Virus Infection ◽

Leukocyte Antigen ◽

Barr Virus ◽

Increased Risk ◽

History Of ◽

Epstein Barr ◽

Barr Virus Infection

Background Both human leukocyte antigen (HLA)-DRB1*15 and Epstein-Barr virus infection presenting as infectious mononucleosis (IM) are recognized as risk factors for multiple sclerosis (MS). However, their combined effect and possible interaction on MS risk is not known. Objective To assess the association between HLA-DRB1*15 and risk of MS in persons with and without IM. Methods We compared the prevalence of DRB1*15 in MS patients with ( n = 76) and without ( n = 1,836) IM with the corresponding distributions in blood donors with ( n = 62) and without ( n = 484) IM histories. This allowed us to estimate the relative risk of MS associated with DRB1*15 in the presence and absence, respectively, of previous IM. We then estimated the interaction between DRB1*15 and IM as the ratio of the two individual odds ratios. Results In IM-naïve individuals, DRB1*15 carried a 2.4-fold (95% confidence interval [CI], 2.0–3.0) increased MS risk. In contrast, among persons with IM history, DRB1*15 was associated with a 7.0-fold (95% CI, 3.3–15.4) increased MS risk. Thus, the MS risk conferred by HLA-DRB1*15 was 2.9 (95% CI, 1.3–6.5)-fold stronger in the presence than in the absence of IM. Combined with previous results, this result indicates that DRB1*15-positive persons with a history of IM may be at a 10.0-fold (95% CI, 6.0–17.9) increased risk of MS compared with persons who are DRB1*15 and IM-naïve. Conclusion DRB1*15 and IM may act in synergy causing MS.

Download Full-text

History of drug allergy: increased risk of allergy to other drugs?

Reactions Weekly ◽

10.2165/00128415-200309750-00012 ◽

2003 ◽

Vol &NA; (975) ◽

pp. 5

Author(s):

&NA;

Keyword(s):

Drug Allergy ◽

Increased Risk ◽

History Of

Download Full-text

Clinical Profile of Adverse Cutaenous Drug Reactions in Patients with Human Immunodeficiency Virus

Althea Medical Journal ◽

10.15850/amj.v7n4.1955 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

Puteri Nabilah Maharani ◽

Oki Suwarsa ◽

Susantina Prodjosoewojo

Keyword(s):

Human Immunodeficiency Virus ◽

Clinical Features ◽

Secondary Data ◽

Stevens Johnson Syndrome ◽

Clinical Feature ◽

Drug Reactions ◽

Hiv Patients ◽

Increased Risk ◽

Immunodeficiency Virus ◽

Cutaneous Drug Reactions

Background: Adverse cutaneous drug reactions (ACDRs) are common problems in patients during the treatment of various diseases. The clinical feature varies from mild manifestation such as morbilliform, urticaria, and contact dermatitis, to severe manifestation such as Stevens - Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Patients infected with the human immunodeficiency virus (HIV) have an increased risk of developing ACDRs due to immune system disruption. This study aimed to describe the clinical features of ACDRs in HIV patients and the drugs that cause ACDRs. Method: This study was a retrospective study using secondary data from medical records of HIV patients with ACDRs who visited Teratai Clinic of Dr. Hasan Sadikin General Hospital Bandung from 2014 to 2018. Total sampling was applied and results were presented in percentage. Results: There were 94 HIV patients with ACDRs out of 557 HIV patients. Adverse cutaneous drug reactions are commonly found in males aged 20-39 years old. The clinical features found were morbilliform (85.6%), SJS (8.9%), urticaria (4.4%), and erythroderma (1.1%). The most common drugs causing ACDRs were Cotrimoxazole (30%), Efavirenz (28.9%), and Nevirapine (16.7%). Conclusion: The prevalence of ACDRs in HIV patients in this study is 16.9%. The most common clinical features are morbilli form and SJS with Cotrimoxazole, Efavirenz, and Nevirapine causing most of the ACDRs.

Download Full-text

Cutaneous Adverse Drug reactions: A Four-Year Study from Western Nepal

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v10i2.20804 ◽

2018 ◽

Vol 10 (2) ◽

pp. 21-26 ◽

Cited By ~ 1

Author(s):

S Neupane ◽

B Basnet

Keyword(s):

Adverse Drug Reactions ◽

College Teaching ◽

Clinical History ◽

Stevens Johnson Syndrome ◽

Drug Reactions ◽

Medical College ◽

Johnson Syndrome ◽

Detailed Clinical History ◽

Life Threatening ◽

History Of

Background: Cutaneous adverse drug reactions (CADRs) range from minor reactions to several life threatening complications. Objectives: To study the clinical spectrum of cutaneous adverse drug reactions, determine the causative drugs responsible for the reactions and to assess the preventability.Methods: The study was carried out in the Department of Dermatology of Gandaki Medical College Teaching Hospital from June 2011 to June 2015. All the patients attending the Dermatology Outpatient Department and the patients admitted in the wards with suspected cutaneous adverse drug reactions to systemic drugs were included in the study. A detailed clinical history, including the history of drug intake was noted. Each case was assessed for its causality by using the WHO definitions. Data analysis was done using SPSS software.Results: There were 102 patients in total. The mean age of the patient was 32 ±15.7 years. Maximum patients belonged to the 21 to 30 years age group. There were 59 female patients and 43 male patients. Severe type of cutaneous adverse drug reactions was noted in 7.8% of patients. Antibiotics were responsible for most of the cutaneous adverse drug reactions. Cefixime was the most commonly incriminated drug. Exanthematous drug reaction was the most common type seen in 45%. Stevens-Johnson syndrome was the commonest type noted among the serious adverse drug reactions. Drug preventability was noted in 6% of patients.Conclusions: The commonest type of CADR noted was exanthematous type. Antibiotics were the commonest drug group involved in CADR. Six percent of CADR were preventable. J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 21-26

Download Full-text

Severe immune-mediated adverse drug reactions and previous history of drug allergy

Paediatrics & Child Health ◽

10.1093/pch/12.3.224 ◽

2007 ◽

Vol 12 (3) ◽

pp. 224-224

Keyword(s):

Adverse Drug Reactions ◽

Drug Allergy ◽

Previous History ◽

Drug Reactions ◽

Immune Mediated ◽

History Of

Download Full-text

History of drug allergy: increased risk of allergy to other drugs?

Inpharma Weekly ◽

10.2165/00128413-200314110-00054 ◽

2003 ◽

Vol &NA; (1411) ◽

pp. 20

Author(s):

&NA;

Keyword(s):

Drug Allergy ◽

Increased Risk ◽

History Of

Download Full-text

Skin testing in cystic fibrosis patients with a history of multiple beta-lactam hypersensitivity reactions

Journal of Cystic Fibrosis ◽

10.1016/s1569-1993(08)60202-7 ◽

2008 ◽

Vol 7 ◽

pp. S53

Author(s):

P. Whitaker ◽

J. Gooi ◽

S. Conway ◽

D. Peckham

Keyword(s):

Cystic Fibrosis ◽

Skin Testing ◽

Hypersensitivity Reactions ◽

Beta Lactam ◽

History Of

Download Full-text

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

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00351 ◽

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.

Download Full-text