scholarly journals Modified Oral Metronidazole Desensitization Protocol

2014 ◽  
Vol 5 (2) ◽  
pp. ar.2014.5.0080 ◽  
Author(s):  
Samantha R. Gendelman ◽  
Lily C. Pien ◽  
Ravi C. Gutta ◽  
Susan R. Abouhassan
Keyword(s):  
Nasal Congestion ◽  
Skin Tests ◽  
Positive Skin ◽  
Intradermal Testing ◽  
History Of ◽  
Desensitization Protocol ◽  
Ige Mediated ◽  
Systemic Symptoms ◽  
Oral Metronidazole ◽  
Oral Desensitization

The Center for Disease Control guidelines recommend desensitization to metronidazole in patients with trichomoniasis and hypersensitivity to metronidazole. There is only one published oral metronidazole desensitization protocol. The purpose of this study was to design a new, more gradual oral desensitization protocol to decrease systemic reactions that may occur when using the previously published protocol. We present two patients with presumed IgE-mediated allergy to metronidazole who underwent oral desensitization using our modified protocol. Case 1 was a 65-year-old woman with trichomoniasis who presented for metronidazole desensitization with a history of intraoperative anaphylaxis and positive skin tests to metronidazole. The patient tolerated six doses of the modified desensitization but developed systemic symptoms of nasal congestion and diffuse pruritus after the 25- and 100-mg doses. Both reactions were treated with intravenous (i.v.) antihistamines. Because of gastrointestinal irritation, the desensitization was completed at a dose of 250 mg orally every 6 hours. Case 2 was a 42-year-old woman with trichomoniasis and a history of hives immediately after administration of i.v. metronidazole who presented for desensitization. The patient had negative skin-prick and intradermal testing to metronidazole. She developed lip tingling and pruritus on her arms 15 minutes after the 10-mg dose. Fexofenadine at 180 mg was given orally and symptoms resolved. She tolerated the rest of the protocol without reaction and received a total dose of 2 g of metronidazole. Our oral metronidazole desensitization for presumed IgE-mediated reactions offers a second option for physicians wishing to use a more gradual escalation in dose.

Penicillin Hypersensitivity

1979 ◽  
Vol 1 (5) ◽  
pp. 132-158
Keyword(s):  
Skin Test ◽  
Multicenter Study ◽  
Positive Skin Test ◽  
Penicillin Allergy ◽  
Skin Tests ◽  
Penicillin G ◽  
Positive Skin ◽  
Positive History ◽  
History Of

A (massive) multicenter study of 3,000 patients has demonstrated that skin tests to penicillin G and penicilloyl-polylysine (PPL-now commercially available) predict and confirm penicillin allergy. Of patients with a history of penicillin reaction, 19% were positive to either, compared to 7% of controls. A history of anaphylaxis led to 46% positive. Of those with a history of urticaria 17% were positive, and those with maculopapular eruptions did not differ from controls (7% positive). Challenge with penicillin led to a reaction in 6% with a positive history (compared to 2% with a negative) and 67% with a combined positive history and positive skin test (to either).

scholarly journals Expedited Desensitization to Canakinumab

2020 ◽  
Vol 11 ◽  
pp. 215265672093769 ◽  
Author(s):  
Neha Sanan ◽  
Jason Schend ◽  
Marija Rowane ◽  
Robert Hostoffer
Keyword(s):  
Inflammatory Diseases ◽  
Interleukin 1 ◽  
Alternative Therapy ◽  
Prior History ◽  
Intradermal Testing ◽  
Immune Modulators ◽  
Fever Syndromes ◽  
Gastrointestinal Intolerance ◽  
History Of ◽  
Desensitization Protocol

Introduction Interleukin-1 (IL-1) antagonists have been successful in the management of monogenic auto-inflammatory diseases, notably classic hereditary fever syndromes, such as Familial Mediterranean Fever (FMF). Anakinra (Kineret®), a human recombinant IL-1 receptor antagonist (IL-1Ra), has been clinically effective in the management of persistent auto-inflammation, such as FMF. Few studies report anaphylaxis in response to anakinra, which were resolved with an anakinra desensitization or the anti-IL-1β monoclonal antibody canakinumab (ILARIS®). We describe the first reported desensitization protocol to canakinumab. Case Report A 51-year-old man with a prior history of FMF presented with history of failed colchicine, nonsteroidal anti-inflammatory drug, and anakinra trials. Anakinra desensitization and canakinumab intradermal testing (IDT) resulted in anaphylactic and allergic symptoms, respectively. Expedited desensitization to canakinumab was successfully performed with 15-minute intervals between 13 doses of incremental increase to 150 mg. Discussion Biological agents are immune modulators that may evoke unanticipated hypersensitivity reactions, including anaphylaxis. These anaphylactic reactions to biologics have been infrequently reported, but the expanding market may increase the risk of IgE-mediated hypersensitivities and subsequent need for desensitization protocols. The current, expedited desensitization evaluated several published protocols involving anakinra desensitization to determine appropriate dosing for canakinumab. Conclusion We report the gastrointestinal intolerance and continued FMF flares on colchicine, followed by anaphylactic responses to anakinra and allergic reaction to IDT of canakinumab, in the present case of FMF. Our novel, expedited canakinumab desensitization protocol serves as an effective and alternative therapy in cases when other appropriate biologic agents are not tolerated.

scholarly journals Epidemiology and drug allergy results in children investigated in allergy unit of a tertiary-care paediatric hospital setting

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
A. Piccorossi ◽  
G. Liccioli ◽  
S. Barni ◽  
L. Sarti ◽  
M. Giovannini ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Hospital Setting ◽  
Clinical History ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Drug Reactions ◽  
Positive Skin ◽  
History Of ◽  
Work Up ◽  
Immediate Reactions

Abstract Background and objective Drug Hypersensitivity Reactions (DHRs) are considered adverse effects of medications that resemble allergy symptoms. The reported positive clinical history of pediatric drug reactions is about 10%, however, after allergy investigations, only a small percent is confirmed as hypersensitivity. The aim of this study was to analyze the clinical history, allergy work-up results and sensitization profile of children and adolescents referred to our Allergy Unit for suspected DHRs. Methods The study evaluated data related to a group of children with a positive history of drug reactions during a two-year period. The allergy work-up consisted of in vivo and in vitro tests, in accordance with the recommendations of the ENDA/EAACI guidelines. Results Data from a group of 637 patients [348 M (54.6%); 289 F (45.4%)] were retrospectively analyzed. Beta lactams (BLs) were the most common drugs involved in the reported clinical history, followed by non-steroidal anti-inflammatory drugs (NSAIDs). Severe cutaneous adverse reactions (SCARs) were most frequently observed during BL treatment. The confirmation of BL hypersensitivity was higher for immediate reactions (IRs) [9.4%; 5.1% through positive skin tests (STs) and 5.5% through drug provocation test (DPT)] compared to non-immediate reactions (non-IRs) (8.1%; 2.2% through STs and 6.2% through DPT). A higher number of positive results was obtained for BLs and macrolides when the tests were performed within 12 months after the index reaction (p < 0.05). During DPTs with amoxicillin-clavulanic acid, four hypersensitivity reactions (including one anaphylaxis) occurred despite negative STs. Conclusion Our data demonstrated that only 9.1% of patients resulted in being positive to allergy tests which is in line with the data in literature. An allergy work-up is mandatory for excluding suspected hypersensitivity.

Skin testing in allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 366-368
Author(s):  
Gayatri Patel ◽  
Carol Saltoun
Keyword(s):  
Skin Test ◽  
Immunoglobulin E ◽  
Clinical Symptoms ◽  
Skin Testing ◽  
Smooth Muscle Contraction ◽  
Skin Tests ◽  
Test Reaction ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Clinical Sensitivity

Skin tests are used in addition to a directed history and physical examination to exclude or confirm immunoglobulin E (IgE) mediated diseases, such as allergic rhinitis, asthma, and anaphylaxis, to aeroallergens, foods, insect venoms, and certain drugs. There are two types of skin testing used in clinical practice: percutaneous testing (prick or puncture) and intracutaneous testing (intradermal). Prick testing involves introducing a needle into the upper layers of the skin through a drop of allergen extract that has been placed on the skin and gently lifting the epidermis up. Various devices are available for prick testing. Intracutaneous (intradermal) testing involves injecting a small amount of allergen into the dermis. The release of preformed histamine from mast cells causes increased vascular permeability via smooth-muscle contraction and development of a wheal; inflammatory mediators initiate a neural reflex, which causes vasodilatation, which leads to erythema (the flare). Prick testing methods are the initial technique for detecting the presence of IgE. These may correlate better with clinical sensitivity and are more specific but less sensitive than intradermal testing. Sites of skin testing include the back and the volar aspect of the arm. By skin testing on the arm, the patient can witness the emergence and often sense the pruritus of the skin test reaction. Because more patients are sensitized (have IgE antibodies and positive skin test reactions) than have corresponding symptoms, the diagnosis of allergy can be made only by correlating skin testing results with the presence of clinical symptoms.

scholarly journals Intradermal Drug Testing following Anaphylactoid Reactions during Anaesthesia

1981 ◽  
Vol 9 (4) ◽  
pp. 381-386 ◽  
Author(s):  
David Sage
Keyword(s):  
Drug Testing ◽  
False Negative ◽  
Skin Tests ◽  
Positive Information ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Negative Results ◽  
False Negative Results ◽  
Intravenous Anaesthetic ◽  
Anaphylactoid Reactions

Intradermal testing of intravenous anaesthetic drugs was performed on 34 patients following acute anaphylactoid reactions during anaesthesia. Twenty-three patients had positive skin tests and 18 of these were positive for a single drug. Muscle relaxants were the drugs implicated most commonly. Intradermal testing is safe and provides useful and often specific positive information, but false-negative results probably occur.

Skin Testing for Penicillin Allergy: Its Limited Value

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 309-309
Author(s):  
Renee K. Bergner
Keyword(s):  
American Academy ◽  
Skin Testing ◽  
Skin Tests ◽  
Penicillin G ◽  
Study Group ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
American Academy Of Pediatrics ◽  
History Of ◽  
Therapeutic Administration

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2

scholarly journals Immediate local anesthetic reactions and diagnostic test results in pediatric patients

2021 ◽  
Vol 49 (3) ◽  
pp. 108-114
Author(s):  
Ahmet Selmanoglu ◽  
Hakan Guvenir ◽  
İlknur Kulhas Celik ◽  
Betul Karaatmaca ◽  
Muge Toyran ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Local Anesthetics ◽  
Pediatric Patients ◽  
Diagnostic Testing ◽  
Challenge Test ◽  
Skin Tests ◽  
Test Results ◽  
Life Threatening ◽  
History Of ◽  
Ige Mediated

Background/objectives: Adverse reactions to local anesthetics are relatively common, but proven IgE-mediated allergy is extremely rare. We aimed to determine the frequency of local anesthetic allergy in pediatric patients.Patients and methods: The medical records of 73 patients who presented to our clinic with a history of suspected allergic reaction to local anesthetics and underwent diagnostic testing between 2012 and 2020 were retrospectively analyzed. Diagnoses were based on case histories, skin tests, and subcutaneous challenge tests.Results: A total of 75 test series were carried out on the 73 patients (43 boys; median [IQR] age 9.25 [7.26–14.25] years, range 3–17.8 years). The most commonly tested drugs were lido-caine (n = 38; 50.6%) and prilocaine (n = 15; 20%). Local anesthetic allergy was confirmed in one (1.3%) of the 73 patients by positive subcutaneous challenge test with mepivacaine. Conclusion: There are limited data in the current literature regarding local anesthetic allergies and diagnosis test results in pediatric patients. Proven local anesthetic allergy is less common than expected by society and physicians, and therefore diagnostic tests are needed for patients with no contra-indications such as severe or life-threatening reactions.

KTP/532 YAG Laser Treatment for Allergic Rhinitis

2009 ◽  
Vol 23 (5) ◽  
pp. 527-530 ◽  
Author(s):  
Eitan Yaniv ◽  
Tuvia Hadar ◽  
Jacob Shvero ◽  
Rami Tamir ◽  
Ben Nageris
Keyword(s):  
Allergic Rhinitis ◽  
Nasal Obstruction ◽  
Nasal Congestion ◽  
Additional Treatment ◽  
Skin Tests ◽  
Nasal Discharge ◽  
Office Procedure ◽  
Positive Skin ◽  
Yag Laser ◽  
Symptom Reports

Background The purpose of this study was to investigate the efficacy of the KTP/532 YAG laser to reduce nasal congestion and discharge in patients with allergic rhinitis. Methods Forty-eight patients with symptoms of allergic rhinitis were treated with the KTP/532 laser. All had positive skin tests for common allergens. Treatments were provided on an ambulatory basis in one to three sessions under local anesthesia with lidocaine nose spray. Outcome was determined by daily symptom reports and regular endoscopy examination and interviews for 12 months. Results Treatment was very well tolerated. There were no major side effects. At examination after 1 year, nasal obstruction was improved in 69% and nasal discharge in 40% of cases. Conclusion The KTP/532 YAG laser is effective for the treatment of nasal obstruction and discharge. Comparison with other techniques showed it to be the most effective in reducing nasal discharge. It can be done as an office procedure and does not damage the nasal mucous membrane. The KTP/532 YAG laser is effective as an additional treatment for patients refractory to medication.

scholarly journals Socioeconomic Status and Childhood Atopy

1996 ◽  
Vol 3 (1) ◽  
pp. 53-57 ◽  
Author(s):  
Kitaw Demissie ◽  
Pierre Ernst ◽  
Margaret R Becklake
Keyword(s):  
Socioeconomic Status ◽  
Social Class ◽  
Skin Test ◽  
Point Of View ◽  
Skin Tests ◽  
Parental Occupation ◽  
Positive Skin ◽  
Before And After ◽  
History Of ◽  
Relationship Of

BACKGROUND:Variation in the prevalence of allergic disorders among socioeconomic groups could be due either to differences in the type of allergens encountered or to actual differences in susceptibility to sensitization to any particular antigen.OBJECTIVE:To examine the relationship of skin test positivity to inhaled aeroallergens and socioeconomic status (SES).METHODS:A total of 989 Montreal elementary school children were studied. A short questionnaire was completed by parents, and the children performed spirometry before and after a free-running exercise challenge. A subsample of 309 children underwent allergy skin prick tests to common inhaled aeroallergens. SES was established using parental occupation.RESULTS:Higher social class was associated with an increased likelihood of having positive skin tests to cat and trees, while there was a trend towards an inverse relationship between SES and skin test sensitivity to cockroach and moulds. Reported history of asthma, hay fever or eczema were unrelated to SES.CONCLUSIONS:The results of this study suggest differences in levels of exposure to different allergens by social class. From the public health point of view, community-based allergen avoidance measures need to be adapted to social class.

Sign in / Sign up

Export Citation Format

Share Document