scholarly journals Drug Allergy Profile From a National Drug Allergy Registry

2021 ◽  
Vol 11 ◽  
Author(s):  
Mona Al-Ahmad ◽  
Jusufovic Edin ◽  
Mosa Fardous ◽  
Tito Rodriguez-Bouza
Keyword(s):  
Respiratory Symptoms ◽  
Drug Allergy ◽  
Drug Hypersensitivity ◽  
Clinical History ◽  
Diagnostic Methods ◽  
Skin Tests ◽  
Presenting Symptoms ◽  
National Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Background: Drug hypersensitivity reactions (DHRs) are among the most frequent reasons for consultation in allergy departments and are becoming more common due to increasing prevalence and case complexity.Objective: To describe the most common drugs associated with clinical reactions, diagnostic methods used, and outcomes of allergic evaluations of a national drug allergy registry over a 12-year period were used.Methods: An observational, prospective, patient’s data registry-based study was conducted to analyze all referrals to the drug allergy outpatient clinics at Al-Rashed Allergy Center, Kuwait, between 2007 and 2019. Demographics, description of DHRs, and results of allergy tests to potential causative medications were reviewed. Diagnostic methods were focused mainly on skin tests (STs) and drug provocation test (DPT), when indicated.Results: We evaluated 1,553 patients with reported DHRs. The mean age of the population was 41.52 ± 16.93 years, and the study population consisted of 63.7% female patients. Hypersensitivity was finally confirmed in 645 (41.5%) of patients, probable in 199 (12.8%), and not confirmed/nonallergic in 709 (45.6%) patients. Anti-inflammatory drugs and analgesics contributed to 39.22% of all confirmed drug allergies, followed by antibiotics 38.1% (β-lactam antibiotics (BLs) constituted 73.98% of all antibiotics and 28.21% of all drugs), anesthetics 1.8%, and radio-contrast media 0.31%. The majority of reactions were non-immediate 51.44%. The most commonly presenting symptoms among confirmed patients were urticaria 57.80%, angioedema 42.50%, respiratory symptoms 47.60%, and erythema 33.60%. Symptoms of anaphylaxis/anaphylactic shock were reported by 284 patients (44.00%) among confirmed cases. The most common method of diagnosis was a positive clinical history (54.4% in BLs and 90.45% in nonsteroidal anti-inflammatory drugs (NSAIDs). Among confirmed allergy to BLs, a positive ST was obtained in 31.9% of patients and positive DPT in 13.7%.Conclusion: NSAIDs and antibiotics, mainly BLs, are the most commonly implicated in confirmed allergy. In both confirmed and not confirmed/nonallergic cases, BLs are the most frequently involved DHRs which are mainly immediate, and the most commonly presenting symptoms were urticaria, angioedema, and respiratory symptoms. Diagnosis was confirmed mainly by a positive clinical history and when indicated, by positive STs or a DPT.

scholarly journals Hypersensitivity reactions to non-steroidal anti-inflammatory drugs: results of an Austrian cohort study

2020 ◽  
Vol 29 (7) ◽  
pp. 227-232
Author(s):  
Teresa Bangerl ◽  
Brigitte Zahel ◽  
Andrea Lueger ◽  
Emmanuella Guenova ◽  
Irena Angelova-Fischer ◽  
...  
Keyword(s):  
Skin Testing ◽  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Clinical History ◽  
University Hospital ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Culprit Drug ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Summary Background Hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is the second most common cause of drug hypersensitivity. Despite the importance of NSAIDs in routine analgesia only few studies have systematically addressed the question of tolerability in hypersensitive patients. Methods The authors retrospectively analysed 398 patients that were treated at the Department of Dermatology, Kepler University Hospital Linz, Austria, in the period 2012–2016 with a clinical history of NSAID hypersensitivity. Skin tests (skin prick and intracutaneous tests) to common NSAIDs were performed, followed by single-blinded, placebo-controlled drug challenge with either the culprit drug or an alternative NSAID. Results A total of 361 patients were subjected to skin testing. Of these, 25 patients (6.3%) showed a positive reaction to the culprit drug. According to the severity of the reaction in the medical history, 87 patients were exposed orally to the culprit drug (oral provocation test, OPT) after negative skin test and 255 patients received OPT with alternative NSAIDs according to established protocols. OPT with the culprit drug resulted in hypersensitivity reactions in 12 patients (13.79%). In terms of alternative NSAID testing, the three most commonly tested drugs were lornoxicam (192 OPTs), acetaminophen (156 OPTs) and celecoxib (133 OPTs) with tolerability rates in respectively 88.54% (hypersensitivity reactions, 11.46%), 92.31% (hypersensitivity reactions, 7.69%) and 91.73% (hypersensitivity reactions, 8.27%) of cases. Conclusion OPT with alternative NSAIDs are useful in patients with NSAID hypersensitivity as tolerability varies between the individual substances.

Management of Respiratory Symptoms Induced by Non-Steroidal Anti-Inflammatory Drugs

2017 ◽  
Vol 4 (2) ◽  
pp. 268-282
Author(s):  
Inmaculada Doña ◽  
María Salas ◽  
Esther Barrionuevo ◽  
Paloma Campo
Keyword(s):  
Respiratory Symptoms ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

ANTI-INFLAMMATORY THERAPY OF THROAT DISEASES

2019 ◽  
Vol 25 (3) ◽  
pp. 53-59
Author(s):  
O.M. Kolesnikova ◽  
◽  
S.A. Karpishchenko ◽  
Y.V. Legkova ◽  
◽  
...  
Keyword(s):  
Quality Of Life ◽  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Symptomatic Treatment ◽  
Diagnostic Methods ◽  
Active Life ◽  
Systemic Antibiotic Therapy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Sore throat is one of the most common complaints faced by doctors of various specialties. This symptom accompanies many diseases of the pharynx and larynx, and may be a manifestation of certain diseases that are not associated with the respiratory tract. When choosing therapy, it is necessary by doctors to rationally use the criteria for the appointment of systemic antibiotic therapy. However, local anti-inflammatory therapy as a symptomatic treatment should be selected before accurate confirmation of the etiology of the disease. This provides patients with a quick return to an active life and an improvement in the quality of life in general. The article discusses the etiology and pathogenesis of pain in diseases of the pharynx, modern diagnostic methods and optimal tactics for treating patients. As a symptomatic treatment, to reduce inflammation in the pharynx, the drug Vertum LOR, which belongs to the group of non-steroidal anti-inflammatory drugs of local action, may contain benzidamine as an active substance.

Four Cases of Drug Allergy Caused by Non-Steroidal Anti-Inflammatory Drugs in Children

2011 ◽  
Vol 21 (4) ◽  
pp. 344 ◽  
Author(s):  
Geun Mi Park ◽  
Ju-Hee Seo ◽  
Hyung Young Kim ◽  
Jinho Yu ◽  
Soo-Jong Hong
Keyword(s):  
Drug Allergy ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

scholarly journals Nonsteroidal anti-inflammatory drugs-induced hypersensitivity reactions

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.

Meloxicam and/or Etoricoxib Could Be Administered Safely in Two Equal Doses during an Open Oral Challenge in Patients with Nonsteroidal Anti-Inflammatory Drug Hypersensitivity

2021 ◽  
pp. 1-7
Author(s):  
Dolly Vanessa Rojas-Mejía ◽  
Diana Lucía Silva Espinosa ◽  
Diana Marcela Martínez ◽  
Luis Fernando Ramírez Zuluaga ◽  
Carlos Daniel Serrano Reyes
Keyword(s):  
Drug Hypersensitivity ◽  
Provocation Test ◽  
Descriptive Study ◽  
Oral Challenge ◽  
Oral Drug ◽  
Hypersensitivity Reactions ◽  
Cross Sectional ◽  
Drug Provocation Test ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

<b><i>Background:</i></b> Hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) are common. These patients require an effective and safe analgesic alternative. <b><i>Objective:</i></b> The aim of the study was to demonstrate the safety of meloxicam and etoricoxib administered by open oral challenge in 2 equal steps in patients with NSAID hypersensitivity. <b><i>Methods:</i></b> A cross-sectional, descriptive study of patients with a diagnosis of NSAID hypersensitivity who underwent an oral drug provocation test (DPT) with meloxicam or etoricoxib between January 2011 and August 2017 was conducted. The analysis was performed from a database in BD Clinic. <b><i>Results:</i></b> Two hundred and twenty-eight oral provocations were performed with an alternative NSAID (203 with meloxicam and 25 with etoricoxib) in 217 patients with hypersensitivity to NSAIDs. The median age was 38 years. Ninety-eight percent of meloxicam and 100% of etoricoxib DPTs were performed in 2 steps (without previous placebo), and 52% and 64% of meloxicam and etoricoxib DPTs, respectively, were performed with 50% of the therapeutic dose in each step. Tolerance to meloxicam was demonstrated in 192 patients (94.5%) and in 100% of patients receiving etoricoxib. <b><i>Conclusions:</i></b> Open oral provocation with meloxicam and etoricoxib carried out in 2 steps without placebo seems to be safe and implies less costs and less time expenditure. Also, it could be performed with 2 equal doses.

scholarly journals Platelet-Adherent Leukocytes Associated With Cutaneous Cross-Reactive Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs

2020 ◽  
Vol 11 ◽  
Author(s):  
Raquel Jurado-Escobar ◽  
Inmaculada Doña ◽  
Gador Bogas-Herrera ◽  
Natalia Pérez-Sánchez ◽  
María Salas ◽  
...  
Keyword(s):  
Acute Phase ◽  
Drug Hypersensitivity ◽  
Arachidonic Acid Metabolism ◽  
Cysteinyl Leukotriene ◽  
Cyclooxygenase 1 ◽  
Drug Hypersensitivity Reactions ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Underlying Mechanisms ◽  
Adherent Leukocytes

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most highly consumed drugs worldwide and the main triggers of drug hypersensitivity reactions. The most frequent reaction, named cross-reactive NSAID-hypersensitivity, is due to the pharmacological activity of these drugs by blocking the cyclooxygenase-1 enzyme. Such inhibition leads to cysteinyl-leukotriene synthesis, mainly LTE4, which are responsible for the reaction. Although the complete molecular picture of the underlying mechanisms remains elusive, the participation of platelet-adherent leukocytes (CD61+) and integrins have been described for NSAID-exacerbated respiratory disease (NERD). However, there is a lack of information concerning NSAID-induced urticaria/angioedema (NIUA), by far the most frequent clinical phenotype. Here we have evaluated the potential role of CD61+ leukocytes and integrins (CD18, CD11a, CD11b, and CD11c) in patients with NIUA, and included the other two phenotypes with cutaneous involvement, NSAID-exacerbated cutaneous disease (NECD) and blended reactions (simultaneous skin and airways involvement). A group NSAID-tolerant individuals was also included. During the acute phase of the reaction, the three clinical phenotypes showed increased frequencies of CD61+ neutrophils, eosinophils, and monocytes compared to controls, which correlated with urinary LTE4 levels. However, no correlation was found between these variables at basal state. Furthermore, increased expressions of CD18 and CD11a were found in the three CD61+ leukocytes subsets in NIUA, NECD and blended reactions during the acute phase when compared with CD61−leukocyte subpopulations. During the acute phase, CD61+ neutrophils, eosinophils and monocytes showed increased CD18 and CD11a expression when compared with CD61+ leukocytes at basal state. No differences were found when comparing controls and CD61+ leukocytes at basal state. Our results support the participation of platelet-adherent leukocytes and integrins in cutaneous cross-hypersensitivity to NSAIDs and provide a link between these cells and arachidonic acid metabolism. Our findings also suggest that these reactions do not involve a systemic imbalance in the frequency of CD61+ cells/integrin expression or levels of LTE4, which represents a substantial difference to NERD. Although further studies are needed, our results shed light on the molecular basis of cutaneous cross-reactive NSAID-hypersensitivity, providing potential targets for therapy through the inhibition of platelet-leukocyte interactions.

Ipersensibilità ai FANS: intolleranza o allergia?

2021 ◽  
Vol 40 (1) ◽  
pp. 37-43
Author(s):  
Laura Levantino ◽  
Cristiana Corrado ◽  
Laura Badina ◽  
Sara Lega ◽  
Egidio Barbi
Keyword(s):  
Drug Hypersensitivity ◽  
Clinical Manifestations ◽  
Hypersensitivity Reactions ◽  
Provocation Tests ◽  
Immunological Mechanisms ◽  
Drug Hypersensitivity Reactions ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Drug Provocation Tests ◽  
Cox 1

Non-steroidal anti-inflammatory drugs (NSAIDs) are the main triggers of drug hypersensitivity reactions in children. According to the EAACI latest classification NSAIDs hypersensitivity reactions are differentiated into cross-reactive reactions, with non-immunological mechanisms (based on COX-1 inhibition), and selective reactions, with immunological mechanisms. Paediatric clinical manifestations of NSAID hypersensitivity are typically cutaneous, but sometimes, similarly to anaphylaxis, can involve other systems, especially the respiratory one. Differentiating between NSAID intolerance and NSAID allergy through drug provocation tests is crucial for the patient because the two clinical entities require different management.

Short-Term Tolerability of Morniflumate in Patients with Cutaneous Hypersensitivity Reactions to Non-Steroidal Anti-Inflammatory Drugs

2013 ◽  
Vol 26 (1) ◽  
pp. 247-250 ◽  
Author(s):  
F. Mero ◽  
E. Nettis ◽  
A.M. Aloia ◽  
E. Di Leo ◽  
A. Ferrannini ◽  
...  
Keyword(s):  
Drug Hypersensitivity ◽  
Antiinflammatory Drug ◽  
Hypersensitivity Reactions ◽  
Short Term ◽  
Cutaneous Hypersensitivity ◽  
Cutaneous Reactions ◽  
Term Tolerability ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Low Incidence

Morniflumate is the morpholinoethyl ester of niflumic acid, a non-steroidal antiinflammatory drug, derived from nicotinic acid. We studied 112 patients who had experienced cutaneous reactions after using non-steroidal anti-inflammatory drugs. Only two of all the patients who underwent an oral challenge with morniflumate had a positive result to the test. By demonstrating the low incidence of reactions to morniflumate through oral challenges, we suggest that patients with non-steroidal anti-inflammatory drug hypersensitivity may tolerate this drug which would therefore be a useful alternative.

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