scholarly journals Quinolone Allergy

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 97 ◽  
Author(s):  
Edoabasi U. McGee ◽  
Essie Samuel ◽  
Bernadett Boronea ◽  
Nakoasha Dillard ◽  
Madison N. Milby ◽  
...  
Keyword(s):  
Clinical Manifestations ◽  
Provocation Test ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Diagnostic Tools ◽  
In Vitro Tests ◽  
Allergic Reactions ◽  
Drug Induced ◽  
Delayed Reaction

Quinolones are the second most common antibiotic class associated with drug-induced allergic reactions, but data on quinolone allergy are scarce. This review article discusses the available evidence on quinolone allergy, including prevalence, risk factors, diagnosis, clinical manifestations, cross-reactivity, and management of allergic reactions. Although the incidence of quinolone allergy is still lower than beta-lactams, it has been increasingly reported in recent decades, most likely from its expanded use and the introduction of moxifloxacin. Thorough patient history remains essential in the evaluation of quinolone allergy. Many diagnostic tools have been investigated, but skin tests can yield false-positive results and in vitro tests have not been validated. The drug provocation test is considered the test of choice to confirm a quinolone allergy but is not without risk. Evidence regarding cross-reactivity among the quinolones is limited and conflicting. Quinolone allergy can be manifested either as an immediate or delayed reaction, but is not uniform across the class, with moxifloxacin posing the highest risk of anaphylaxis. Quinolone should be discontinued when an allergic reaction occurs and avoided in future scenarios, but desensitization may be warranted if no alternatives are available.

scholarly journals AN ANTIBIOTIC DRUG-INDUCED ALLERGIC REACTION IN A PATIENT WITH MULTIPLE COMORBIDITIES. CLINICAL CASE

2020 ◽  
pp. 211-214
Author(s):  
G. E. Kuodza ◽  
P. O. Kolesnyk
Keyword(s):  
Allergic Reaction ◽  
Management Plan ◽  
Medical Attention ◽  
Allergic Reactions ◽  
Drug Induced ◽  
Delayed Reaction ◽  
Provocation Tests ◽  
Drug Eruptions ◽  
Antibiotic Drug

Drug induced allergic reactions due to antibiotics rarely occur. Penicillin is the antibiotic class that is mostly commonly associated with drug induced allergic reactions (10 %). They are followed by quinolones (2 %) which will be discussed in this case based review. Fluoroquinolones allergic reactions can either present as an immediate reaction which requires urgent medical attention or a delayed reaction. Among the antibiotics of this class, moxifloxacin has been reported as the drug which is likely to result in occurrence of an allergic reaction. Some of the dermatologic eruptions that could manifest include maculopapular exanthema, urticarial, Steven Johnson Syndrome, fixed drug eruptions and drug rash with eosinophilia and systemic symptoms (DRESS). The diagnosis needs a thorough history and physical examination, skin test, in vitro testing and drug provocation tests. Management includes discontinuation of the provoking agent and administration of antihistamines or corticosteroids depending on the situation. The case of the 75 year old lady who had an allergic reaction following administrations of ciprofloxacin and follow up management plan is described in the article. The case illustrates and urgent necessity of quaternary prevention in primary care to avoid harming patients while choosing the best and safe therapy.

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

2016 ◽  
Vol 4 (1) ◽  
pp. 1 ◽  
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.

scholarly journals Drug reexposure in children with severe mucocutaneous reactions

2022 ◽  
Vol 50 (1) ◽  
pp. 104-107
Author(s):  
Luis Moral ◽  
Teresa Toral ◽  
Ana Gilabert ◽  
Ares Sánchez ◽  
Juan Francisco Silvestre ◽  
...  
Keyword(s):  
Adverse Reactions ◽  
Provocation Test ◽  
Skin Tests ◽  
In Vitro Tests ◽  
Severe Reaction ◽  
Pediatric Allergy ◽  
Drug Provocation Test ◽  
History Of ◽  
Cutaneous Adverse Reactions

In pediatric patients, severe cutaneous adverse reactions (SCARs) frequently occur in the course of acute illnesses, mostly infections, which are usually treated with antibiotics or analgesics. The drug provocation test (DPT) is contraindicated in such situations, due to the risk of triggering a new severe reaction. As a consequence, lifelong avoidance is recommended. However, causation is uncertain in most cases. The dilemma arises when avoiding the drug is not harmless for the patient. We have attended three patients who were referred to our pediatric allergy unit with a history of SCAR related in time to simultaneous use of paracetamol and ibuprofen. Medical records and images of the patients were reviewed with the assistance of a dermatologist, and alternative diagnoses were considered in both cases. The ALDEN score for implicated drugs was calculated. After considering a high probability of ibuprofen tolerance and obtaining informed consent from the patients, we performed a sequential allergy workup including in vitro tests, skin tests, and finally DPT in two of the patients, confirming ibuprofen tolerance. In conclusion, although generally contraindicated, DPT may be considered for some useful drugs after careful evaluation of the risk–benefit balance, preceded by a sequential study including in vitro and skin tests.

Immediate Allergic Reactions to β-Lactams: Diagnosis and Therapy

2003 ◽  
Vol 16 (1) ◽  
pp. 19-23 ◽  
Author(s):  
A. Romano ◽  
C. Mondino ◽  
M. Viola ◽  
P. Montuschi
Keyword(s):  
Anaphylactic Shock ◽  
Specific Ige ◽  
Ring Structure ◽  
Skin Tests ◽  
In Vitro Tests ◽  
Allergic Reactions ◽  
In Vitro Test ◽  
Immunological Mechanisms

β-Lactams are the antibiotics which most frequently provoke adverse reactions mediated by specific immunological mechanisms. These reactions, classifiable as immediate or non-immediate, can be produced by the four classes of β-lactams (penicillins, cephalosporins, carbapenems and monobactams) currently available, which share a common β-lactam ring structure. Immediate reactions occur within the first hour after drug administration and are characterized by urticaria, angioedema, rhinitis, bronchospasm, and anaphylactic shock. Immediate reading skin tests are the quickest and most reliable method for demonstrating the presence of β-lactam specific IgE antibodies. It is crucial to use in diagnosis the suspected β-lactams themselves, particularly cephalosporins, in addition to penicillin determinants. Serum specific IgE assays can be used as complementary tests. Negative test results should be interpreted in light of the time elapsed from the last exposure to the responsible β-lactam. In fact, both in vivo and in vitro test sensitivity is known to decrease over time. In some diagnostic work-ups, patients with a positive history and negative skin and in vitro tests with classic reagents undergo a controlled administration of the suspected β-lactam. The management of immediate allergic reactions should take into consideration their severity and type. Adrenaline is the drug of choice in the treatment of anaphylactic shock. In addition to adrenaline, corticosteroids and antihistamines should be administered. Histamine H1 receptor antagonists are the mainstay of the treatment of immediate allergic reactions such as urticaria, rhinitis and conjunctivitis.

scholarly journals Approaches to the Management of Presumed Immediate Hymenoptera Venom Allergy and Non-Detectable IgE

2010 ◽  
Vol 3 (1) ◽  
pp. 16-23
Author(s):  
Ervin Ç. Mingomataj ◽  
Alketa H. Bakiri
Keyword(s):  
Skin Test ◽  
Case Reports ◽  
Skin Tests ◽  
Diagnostic Tools ◽  
In Vitro Tests ◽  
Insect Allergy ◽  
History Of ◽  
Cellular Tests

Objective: To provide a comprehensive evaluation in patients with a convincing history of immediate insect allergy but negative skin test and/or specific IgE results, adequately addressing the question of how best to manage them. Data sources: Observational peer-reviewed studies and case reports were searched on Pub-Med database from 1998 up to March 2009 using the following keywords: Hymenoptera Allergy & Negative IgE (Negative Skin Tests). Study selection: Studies on supplemental diagnostic tests that provided data from patients with immediate hymenoptera allergy but negative conventional tests results to the offending allergens were selected. In this work, we also included studies providing additional relevant information regarding this issue. Results: Among 43 identified papers only 9 of them presented relevant original data, while the other papers were reviews. In the majority of the cases, the culprit insect was identified with in vitro tests such as Basophil Activation Test, Cellular Allergen Stimulation Test or Western blot, whereas in vivo (less frequently) with sting challenge or dialyzed venom skin test. Conclusions: The management of patients with a convincing history of immediate insect allergy but negative conventional test results requires an adaption of the guidelines including an incorporation of the novel diagnostic tools. Although cellular tests represent equivalent sensitivity and superior specificity as compared with standard ones, these tests still remain supplementary diagnostic tools. In a minority of cases (especially in the developing countries where cellular tests cannot be performed), venom immunotherapy in adult subjects could be taken into account based solemnly on the history of a clear patient’s identification of the culprit insect.

КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ ПИЩЕВЫХ АЛЛЕРГЕНОВ ЖИВОТНОГО ПРОИСХОЖДЕНИЯ

2019 ◽  
Author(s):  
A.N. Pampura ◽  
E.E. Varlamov
Keyword(s):  
Clinical Manifestations ◽  
Red Meat ◽  
Cross Reactivity ◽  
Allergic Reactions ◽  
Essential Nutrients ◽  
Animal Products ◽  
Food Animal ◽  
Mammalian Meat

Продукты животного происхождения обладают наиболее сбалансированным комплексом необходимых нутриентов, поэтому их включение в пищевой рацион оправданно в различные возрастные периоды. Клинические проявления аллергии к данным продуктам крайне разнообразны. Одним из ключевых аспектов обозначенной проблемы является диагностика и оценка вероятности развития перекрестной реактивности. К пищевым продуктам животного происхождения, наиболее часто индуцирующим симптомы, относятся коровье молоко, куриное яйцо, рыба, моллюски, ракообразные, мясо млекопитающих. В представленной статье изложены данные об основных классах пищевых аллергенов животного происхождения, индуцирующих развитие перекрестных аллергических реакций. Описаны синдромы, связанные с перекрестной реактивностью: птица-яйцо , кошка-свинина , рыба-курица и -Gal-синдром/ синдром красного мяса .Animal foods products contain the most balanced complex of essential nutrients. The clinical manifestations of allergy to these products are varied. Key aspect of this problem is diagnostics and assessment of cross-reactivity. The food animal products that more often induce symptoms include cows milk, hens egg, fish, mollusks, crustaceans, mammalian meat. Data on the main classes of food animal allergens inducing the development of cross-allergic reactions as well as syndromes associated with cross-reactivity like bird-egg , cat-pork , fish-chicken and a-Gal-syndrome/ red meat syndrome are described in this article.

scholarly journals Allergy to cephalosporin antibiotics in children

2003 ◽  
Vol 131 (3-4) ◽  
pp. 127-130 ◽  
Author(s):  
Marina Atanaskovic-Markovic ◽  
Branimir Nestorovic
Keyword(s):  
Allergic Reaction ◽  
Cross Reactivity ◽  
Skin Tests ◽  
Allergic Reactions ◽  
First Line ◽  
Positive Skin ◽  
Cephalosporin Antibiotics ◽  
The Cross ◽  
Single Blind ◽  
Common Infections

A particular problem is the safety of administering cephalosporins to penicillin-allergic children, because cephalosporin allergenic determinants have not been properly identified. Cephalosporin antibiotics are widely used to treat common infections and are often the first-line prophylaxis before many types of surgery. So the arm of this study is to determine the frequency of allergic reactions of anaphylactic type to cephalosporins and their cross-reactivity with penicillins. At University Children?s Hospital in Belgrade a group of 1,170 children with suspected anaphylactic allergic reaction to penicillins and/or cephalosporins were tested for the last eight years. Skin tests were performed with standard concentration of penicillins and cephalosporins. In children where skin tests were negative single-blind placebo-controlled challenges were performed. In case of positive skin tests further examinations were interrupted and the children were considered allergic to that drug. The frequency of anaphylactic allergic reactions to cephalosporins is 0.2 % to 17 %, and depends on cephalosporins generation. The cross-reactivity between cephalosporins and penicillins is 0.1 % to 14.5 %, and among cephalosporins is 0 % to 11.7 %.

scholarly journals Recombinant in vitro test T-SPOT.TB as a screening method for early diagnosis of tuberculosis infection

2020 ◽  
Vol 98 (4) ◽  
pp. 48-52
Author(s):  
E. P. Eremenko ◽  
E. A. Borodulina ◽  
I. A. Sergeeva ◽  
D. A. Kudlay ◽  
B. E. Borodulin
Keyword(s):  
Screening Method ◽  
Latent Tuberculosis ◽  
Tuberculosis Infection ◽  
Mantoux Test ◽  
Skin Tests ◽  
In Vitro Tests ◽  
In Vitro Test ◽  
Healthy Children ◽  
Vitro Test

In addition to standard skin tests (Mantoux test with 2 TU PPD-L and diaskintest) for the diagnosis of tuberculosis infection, in vitro tests are used. One of these tests is T-SPOT.TB being more widely used in recent years.The objective: to evaluate the effectiveness of T-SPOT.TB test for early detection of tuberculosis infection in children and adolescents in Samara Region.Subjects and methods. From 2016 to 2019, results of T-SPOT.TB tests performed in 596 children aged 2 to 17 years inclusive were analyzed; those children had no immunodiagnosis of tuberculosis infection using skin tests since their parents refused to have it.Results. It was found out that the major reason for refusing skin tests was the “fear” of visiting a TB dispensary if the result had been positive — 38.43% (n = 229). The latent tuberculosis infection according to the results of T-SPOT.TB among children with concomitant pathology made 2.6%, among healthy children – 0.7%.Conclusion. T-SPOT.TB test may be used as an alternative method for diagnosis of tuberculosis infection, should the parent refuse to have skin tests. In children with concomitant pathology, T-SPOT.TB test can serve as a leading method for immunodiagnosis of tuberculosis.The authors state that they have no conflict of interests.

scholarly journals Neo-antigens for the serological diagnosis of IgE-mediated drug allergic reactions to antibiotics cephalosporin, carbapenem and monobactam

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Edurne Peña-Mendizabal ◽  
Sergi Morais ◽  
Ángel Maquieira
Keyword(s):  
Drug Allergy ◽  
High Sensitivity ◽  
Specific Ige ◽  
In Vitro Tests ◽  
Allergic Reactions ◽  
Serum Samples ◽  
Lactam Ring ◽  
Specific Igg ◽  
Ige Mediated

Abstract New antigens deriving from -lloyl and -llanyl, major and minor determinants, respectively, were produced for β-lactam antibiotics cefuroxime, cefotaxime, ceftriaxone, meropenem and aztreonam. Twenty β-lactam antigens were produced using human serum albumin and histone H1 as carrier proteins. Antigens were tested by multiplex in vitro immunoassays and evaluated based on the detection of specific IgG and IgE in the serum samples. Both major and minor determinants were appropriate antigens for detecting specific anti-β-lactam IgG in immunised rabbit sera. In a cohort of 37 allergic patients, we observed that only the minor determinants (-llanyl antigens) were suitable for determining specific anti-β-lactam IgE antibodies with high sensitivity (< 0.01 IU/mL; 24 ng/L) and specificity (100%). These findings reveal that not only the haptenisation of β-lactam antibiotics renders improved molecular recognition events when the 4-member β-lactam ring remains unmodified, but also may contribute to develop promising minor antigens suitable for detecting specific IgE-mediated allergic reactions. This will facilitate the development of sensitive and selective multiplexed in vitro tests for drug-allergy diagnoses to antibiotics cephalosporin, carbapenem and monobactam.

scholarly journals IPEX Syndrome: Improved Knowledge of Immune Pathogenesis Empowers Diagnosis

2021 ◽  
Vol 9 ◽  
Author(s):  
Federica Barzaghi ◽  
Laura Passerini
Keyword(s):  
Late Onset ◽  
Clinical Manifestations ◽  
Foxp3 Expression ◽  
Cell Receptor ◽  
Histological Evaluation ◽  
Diagnostic Tools ◽  
Atypical Symptoms ◽  
Advanced Therapies ◽  
Classical Triad

Immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX) syndrome is a rare monogenic autoimmune disease with variable clinical manifestations, ranging from early-onset severe autoimmunity, including enteropathy, eczema, and type 1 diabetes, to late-onset or atypical symptoms. Despite the clinical heterogeneity, the unifying feature of IPEX is mutation of the FOXP3 gene, which encodes a transcription factor essential for maintenance of thymus-derived regulatory T cells (Tregs). In IPEX patients, Tregs can be present, although unstable and impaired in function, unable to inhibit proliferation and cytokine production of effector T (Teff) cells. Mutated FOXP3 can also disrupt other compartments: FOXP3-deficient Teff cells proliferate more than the wild-type counterpart, display altered T-cell-receptor signaling response, a reduced T-naïve compartment and a skew toward a Th2 profile. Due to FOXP3 mutations, the frequency of autoreactive B cells is increased and the IgA and IgE production is altered, together with early emergence of tissue-specific autoantibodies. Recently, the awareness of the wide clinical spectrum of IPEX improved the diagnostic tools. In cases presenting with enteropathy, histological evaluation is helpful, although there are no pathognomonic signs of disease. On the other hand, the study of FOXP3 expression and in vitro Treg function, as well as the detection of specific circulating autoantibodies, is recommended to narrow the differential diagnosis. Nowadays, Sanger sequencing should be limited to cases presenting with the classical triad of symptoms; otherwise, next-generation sequencing is recommended, given the cost-effectiveness and the advantage of excluding IPEX-like syndromes. The latter approach could be time spearing in children with severe phenotypes and candidate to advanced therapies.

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