scholarly journals Unusual Reactions to Hymenoptera Stings: Current Knowledge and Unmet Needs in the Pediatric Population

2021 ◽  
Vol 8 ◽  
Author(s):  
Riccardo Castagnoli ◽  
Mattia Giovannini ◽  
Francesca Mori ◽  
Simona Barni ◽  
Luca Pecoraro ◽  
...  
Keyword(s):  
Therapeutic Approach ◽  
Unmet Needs ◽  
Current Knowledge ◽  
Pediatric Population ◽  
Clinical Manifestations ◽  
Delayed Hypersensitivity ◽  
Hypersensitivity Reactions ◽  
Pathogenetic Mechanisms ◽  
Management Algorithm ◽  
Local Reactions

Hymenoptera stings are generally well-tolerated and usually cause limited local reactions, characterized by self-resolving erythema and edema associated with pain. However, Hymenoptera stings can induce immediate and delayed hypersensitivity reactions. In addition to these manifestations, unusual reactions to Hymenoptera stings have been reported. The latter are defined as unusual because of their atypical characteristics. They may differ from classical hypersensitivity reactions due to the stings' particular localization and the unusual involvement of one or more specific organs. Although unusual reactions to Hymenoptera stings are infrequent, it is essential for clinicians to know the possible related clinical manifestations. Here, we review the available literature and propose a diagnostic and management algorithm. At present, there are no defined guidelines for most of the unusual reactions to Hymenoptera stings, which should be managed in a tailored way according to the specifical clinical manifestations presented by the patients. Further studies are needed to better define these conditions and the underlying pathogenetic mechanisms to improve the diagnostic and therapeutic approach.

Hypersensitivity reactions to proton-pump inhibitors: Clinical presentation, diagnosis, and management

2020 ◽  
Vol 41 (2) ◽  
pp. e37-e44 ◽  
Author(s):  
Seçil Kepil Özdemir ◽  
Sevim Bavbek
Keyword(s):  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Clinical Presentation ◽  
Current Knowledge ◽  
Cross Reactivity ◽  
Delayed Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Fixed Drug Eruption ◽  
Maculopapular Eruption

Background: Proton-pump inhibitors (PPI) are one of the most commonly prescribed drugs, and they are generally well tolerated. However, several immediate and delayed hypersensitivity reactions due to PPIs have been reported. Objective: To review the clinical characteristics and management of immune-mediated immediate and delayed hypersensitivity reactions to PPIs. Methods: We performed a search of a medical literature data base from January 1980 to October 2019 by using keywords that included “proton-pump inhibitors” and “hypersensitivity.” Results: Anaphylaxis is the most-common clinical presentation in patients with immediate hypersensitivity reactions to PPIs, followed by urticaria and/or angioedema. Occupational contact dermatitis, maculopapular eruption, fixed drug eruption, symmetrical drug-related intertriginous and flexural exanthema, and severe cutaneous adverse reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, and acute generalized exanthematous pustulosis have also been reported with PPIs. Conclusion: The current knowledge and severity of the reported reactions indicated the importance of consideration of a causal relationship between hypersensitivity reactions and PPIs, and awareness of the existence of cross-reactivity among PPIs.

Acute Cocaine Toxicity: Pharmacology and Clinical Presentations in Adult and Pediatric Populations

2000 ◽  
Vol 13 (2) ◽  
pp. 159-169 ◽  
Author(s):  
Jack W. Lipton ◽  
Kile P. Mangan ◽  
Jean M. Silvestri
Keyword(s):  
Current Knowledge ◽  
Pediatric Population ◽  
Healthcare Providers ◽  
Clinical Manifestations ◽  
Symptom Presentation ◽  
Cocaine Exposure ◽  
Demographic Groups ◽  
Pediatric Populations ◽  
Pharmacologic Activity ◽  
Cocaine Toxicity

Cocaine remains the most prevalent drug responsible for emergency department (ED) visits. A majority of acute cocaine toxicity cases involve young, habitual, adult cocaine users and often present with a range of cardiac, neurologic, gastrointestinal (GI) or renal symptoms. In addition, atypical populations (neonates, infants, toddlers, young children and adolescents) are presenting in EDs with varying symptoms that are unknowingly associated with cocaine exposure. Unfortunately, juvenile presentations are generally anecdotal in nature, and while enlightening, are difficult to quantify epidemiologically. Outlining the types of symptom presentation in these young populations may assist healthcare providers in expediting proper treatment for such demographic groups. Therefore, this review examines the current knowledge regarding cocaine's pharmacologic activity as it relates to its potential toxicity, and outlines the clinical manifestations of cocaine exposure and toxicity in adult and pediatric populations. We conclude from the available clinical reports that there must be a higher index of suspicion in the pediatric population to identify exposed infants and children. Improved recognition and identification in both typical and atypical populations will result in better characterization of acute cocaine toxicity.

scholarly journals Delayed Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review

2020 ◽  
Vol 30 (6) ◽  
pp. 400-408
Author(s):  
ML Caballero ◽  
S Quirce
Keyword(s):  
Literature Review ◽  
Active Substance ◽  
Clinical Manifestations ◽  
Delayed Hypersensitivity ◽  
European Medicines Agency ◽  
Hypersensitivity Reactions ◽  
Skin Disorders ◽  
Systemic Reactions ◽  
Pharmaceutical Form ◽  
Life Threatening

The European Medicines Agency (EMA) defines excipients as the constituents of a pharmaceutical form apart from the active substance. Delayed hypersensitivity reactions (DHRs) caused by excipients contained in the formulation of medications have been described. However, there are no data on the prevalence of DHRs due to drug excipients. Clinical manifestations of allergy to excipients can range from skin disorders to life-threatening systemic reactions. The aim of this study was to perform a literature review on allergy to pharmaceutical excipients and to record the DHRs described with various types of medications, specifically due to the excipients contained in their formulations. The cases reported were sorted alphabetically by type of medication and excipient, in order to obtain a list of the excipients most frequently involved for each type of medication.

Facts and myths on recurrent vulvovaginal candidosis—a review on epidemiology, clinical manifestations, diagnosis, pathogenesis and therapy

2002 ◽  
Vol 13 (8) ◽  
pp. 522-539 ◽  
Author(s):  
Per-Anders Mårdh ◽  
Acacio G Rodrigues ◽  
Mehmet Genç ◽  
Natalia Novikova ◽  
J Martinez-de-Oliveira ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antimicrobial Therapy ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
Health Providers ◽  
Behaviour Modification ◽  
Pathogenetic Mechanisms ◽  
Vulvovaginal Candidosis ◽  
Candida Infections ◽  
Affected Woman

Approximately three-quarters of all women will experience an episode of vulvovaginal candidosis at least once in their life and 5-10% of them will have more than one attack. Women suffering from three to four attacks within 12 months will be diagnosed with recurrent vulvovaginal candidosis (RVVC). This review covers the large number of proposed aetiological factors for RVVC. The diagnosis of the condition made by conventional means by health providers is often false and is also often misdiagnosed by the affected woman herself. The review covers various methods of diagnosing RVVC and the current knowledge on potential pathogenetic mechanisms proposed for genital candida infections. Treatment of RVVC, including local and systemic antimicrobial therapy and behaviour modification to decrease the risk of recurrences, are discussed. Recent knowledge on drug resistance in candida is also included.

Early Biomarkers for Severe Drug Hypersensitivity Reactions

2019 ◽  
Vol 25 (36) ◽  
pp. 3829-3839 ◽  
Author(s):  
Adriana Ariza ◽  
Maria J. Torres ◽  
Carmen Moreno-Aguilar ◽  
Rubén Fernández-Santamaría ◽  
Tahia D. Fernández
Keyword(s):  
Drug Exposure ◽  
Drug Hypersensitivity ◽  
Clinical Manifestations ◽  
Skin Tests ◽  
Time Interval ◽  
Hypersensitivity Reactions ◽  
Early Biomarkers ◽  
Immunological Mechanisms ◽  
Drug Hypersensitivity Reactions ◽  
Delayed Reactions

Drug hypersensitivity reactions (DHRs) are typically classified into immediate and delayed reactions based on the time interval between drug exposure and onset of symptoms. Clinical manifestations range from mild to severe and life-threatening reactions. The most severe clinical entities are anaphylaxis and anaphylactic shock for immediate reactions, and severe cutaneous adverse reactions such as Steven Johnson Syndrome and Toxic Epidermal Necrolysis for delayed reactions. The diagnosis is complex and challenging, as drug provocation tests and even skin tests can be very risky procedures, which makes them not recommended. Therefore, it is necessary to search for useful early biomarkers to manage the diagnosis of these reactions. These biomarkers could be useful to determine the clinical entity, but not to identify the culprit drug. Some of the currently available biomarkers are few genetic associations of drug allergy with polymorphisms of human leukocyte antigen (HLA), the detection of inflammatory and lipid mediators in serum, or the detection of cytokines, chemokines, and cytotoxic markers in skin biopsies. In this literature review, it has been summarize the immunological mechanisms involved in severe reactions, both immediate and delayed, and different early biomarkers: those currently used for the diagnosis of these reactions as well as possible early biomarkers that could be useful with further studies to standardize their clinical use.

scholarly journals Pan-American Lancehead Pit-Vipers: Coagulotoxic Venom Effects and Antivenom Neutralisation of Bothrops asper and B. atrox Geographical Variants

Toxins ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 78
Author(s):  
Lachlan A. Bourke ◽  
Christina N. Zdenek ◽  
Edgar Neri-Castro ◽  
Melisa Bénard-Valle ◽  
Alejandro Alagón ◽  
...  
Keyword(s):  
Evolutionary Biology ◽  
Current Knowledge ◽  
Clinical Manifestations ◽  
In Vivo Studies ◽  
Factor X ◽  
Clotting Factors ◽  
Bothrops Asper ◽  
Species Specific

The toxin composition of snake venoms and, thus, their functional activity, can vary between and within species. Intraspecific venom variation across a species’ geographic range is a major concern for antivenom treatment of envenomations, particularly for countries like French Guiana that lack a locally produced antivenom. Bothrops asper and Bothrops atrox are the most medically significant species of snakes in Latin America, both producing a variety of clinical manifestations, including systemic bleeding. These pathophysiological actions are due to the activation by the venom of the blood clotting factors Factor X and prothrombin, thereby causing severe consumptive coagulopathy. Both species are extremely wide-ranging, and previous studies have shown their venoms to exhibit regional venom variation. In this study, we investigate the differential coagulotoxic effects on human plasma of six venoms (four B. asper and two B. atrox samples) from different geographic locations, spanning from Mexico to Peru. We assessed how the venom variation of these venom samples affects neutralisation by five regionally available antivenoms: Antivipmyn, Antivipmyn-Tri, PoliVal-ICP, Bothrofav, and Soro Antibotrópico (SAB). The results revealed both inter- and intraspecific variations in the clotting activity of the venoms. These variations in turn resulted in significant variation in antivenom efficacy against the coagulotoxic effects of these venoms. Due to variations in the venoms used in the antivenom production process, antivenoms differed in their species-specific or geographical neutralisation capacity. Some antivenoms (PoliVal-ICP, Bothrofav, and SAB) showed species-specific patterns of neutralisation, while another antivenom (Antivipmyn) showed geographic-specific patterns of neutralisation. This study adds to current knowledge of Bothrops venoms and also illustrates the importance of considering evolutionary biology when developing antivenoms. Therefore, these results have tangible, real-world implications by aiding evidence-based design of antivenoms for treatment of the envenomed patient. We stress that these in vitro studies must be backed by future in vivo studies and clinical trials before therapeutic guidelines are issued regarding specific antivenom use in a clinical setting.

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