scholarly journals Antibiotic Hypersensitivity Mechanisms

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 122 ◽  
Author(s):  
Jenana H. Maker ◽  
Cassandra M. Stroup ◽  
Vanthida Huang ◽  
Stephanie F. James
Keyword(s):  
Bacterial Infections ◽  
Signs And Symptoms ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Type Iv ◽  
Immune Mediated ◽  
Different Types ◽  
Ige Mediated ◽  
Antibiotic Reactions ◽  
Immune Complex Formation

Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions.

scholarly journals Ketorolac induced non allergic angioedema: A case report

2020 ◽  
Vol 11 (3) ◽  
pp. 4342-4346
Author(s):  
Chinju ◽  
Mahesh P A ◽  
Shilpa Palaksha
Keyword(s):  
Early Recognition ◽  
Hypersensitivity Reactions ◽  
Lipoxygenase Pathway ◽  
Immunological Mechanism ◽  
Immune Mediated ◽  
Different Types ◽  
Diagnostic Difficulties ◽  
Adults And Children ◽  
Ige Mediated ◽  
Inflammatory Drugs

Non- Steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed category of drugs. NSAIDs are the main cause of allergic reactions both in adults and children. Hypersensitivity reactions due to NSAIDs involve 0.3% to 0.5% of the overall population. Among the different types of NSAIDs induced hypersensitivity reactions, urticaria and angioedema are the most common. Angioedema can be of two types, allergic(IgE) & Nonallergic( Non IgE) mediated. Allergic angioedema is immune mediated but non allergic angioedema mimic immune mediated allergic reaction without underlying evidence of immunological mechanism which can cause diagnostic difficulties for the clinician. Distinguishing immune-mediated and non-immune-mediated reactions can be difficult, so careful evaluation is needed. Pathomechanism of NSAIDs induced non allergic angioedema is based on cysteniyl leukotrienes and bradykinin pathway in which NSAIDs block cyclo oxygenase pathway and directs the lipoxygenase pathway and generates leukotrienes which result in the development of angioedema. NSAIDs induced allergic angioedema is quite frequent and NSAIDs induced nonallergic angioedema are quite rare.The detailed information of these reactions is necessary to decrease morbidity and mortality associated with the reactions.The early recognition and discontinuation of suspected drug should be done in order to avoid further complications. Here, we report a case of a patient with non allergic angioedema in association with use of Ketorolac.

scholarly journals Tolerability of Cefazolin after Immune-Mediated Hypersensitivity Reactions to Nafcillin in the Outpatient Setting

2014 ◽  
Vol 58 (6) ◽  
pp. 3137-3143 ◽  
Author(s):  
Kimberly G. Blumenthal ◽  
Ilan Youngster ◽  
Erica S. Shenoy ◽  
Aleena Banerji ◽  
Sandra B. Nelson
Keyword(s):  
Bacterial Infections ◽  
Massachusetts General Hospital ◽  
Cohort Analysis ◽  
Maculopapular Rash ◽  
Outpatient Setting ◽  
Hypersensitivity Reactions ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Monitoring Therapy ◽  
Immune Mediated ◽  
Ige Mediated

ABSTRACTThe objective of the present study was to assess the safety and tolerability of cefazolin therapy among patients with methicillin-sensitive Gram-positive bacterial infections who develop non-IgE-mediated hypersensitivity reactions (HSRs) to nafcillin. In this retrospective cohort analysis of the Outpatient Parenteral Antimicrobial Therapy program at the Massachusetts General Hospital from 2007 through 2013, we identified patients switched from nafcillin to cefazolin after an immune-mediated HSR. We reviewed patient demographics, details about the original HSR, and outcomes after the switch to cefazolin therapy. HSRs were classified by reaction type and likely mechanism. There were 467 patients treated with nafcillin, of which 60 (12.8%) were switched to cefazolin during their prescribed course. Of the 60 patients who transitioned to cefazolin, 17 (28.3%) were switched because of non-IgE-mediated HSRs. HSRs included maculopapular rash (n= 10), immune-mediated nephritis (n= 3), isolated eosinophilia (n= 2), immune-mediated hepatitis (n= 1), and a serum sickness-like reaction (n= 1). All but one patient (94.1%) who switched to cefazolin tolerated the drug with resolution of the HSR and completed their therapy with cefazolin. No patient experienced worsening of their rash or progressive organ dysfunction. With appropriate monitoring, therapy with cefazolin after non-IgE-mediated HSRs to nafcillin appears to be safe.

scholarly journals Immune-Mediated Tissue Injury (Hypersensitivity Reactions)

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Gerald J Prud'homme
Keyword(s):  
Tissue Injury ◽  
Granulomatous Inflammation ◽  
Delayed Type Hypersensitivity ◽  
Target Cells ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Fixed Tissue ◽  
Type Iv ◽  
Immune Mediated ◽  
Type V

Hypersensitivity is synonymous with immune-mediated tissue injury. Hypersensitivity reactions occur in several forms and give rise to numerous conditions including allergies, autoimmune disease, allograft rejection, granulomatous inflammation, and a variety of acute or chronic inflammatory disorders (vasculitis, glomerulonephritis, arthritis, pneumonitis, encephalitis, etc.). While hypersensitivity is usually detrimental, in some cases it represents a normal response to a pathogen (e.g., the granulomatous inflammation of tuberculosis). Several years ago, Gell and Coombs divided hypersensitivity states into four basic types (1), and this classification remains useful today (Table 1). Type I hypersensitivity reactions result from IgE-dependent degranulation of mast cells or basophils. Type II, or "cytotoxic" hypersensitivity, results from the binding of IgG or IgM antibodies to cell membranes or fixed tissue antigens, causing activation of the complement system. Type III, or "immune-complex" hypersensitivity, results from the formation of immune complexes that precipitate in tissues (or form in situ), also with activation of complement. Type IV, or "cell-mediated" reactions, can be subdivided into two basic types: type IV-A is synonymous with delayed-type hypersensitivity (DTH) and usually occurs in response to soluble antigens; type IV-B results from the direct killing of target cells by cytotoxic T lymphocytes (CTL). Stimulation of cells by anti-receptor autoantibodies (such as the anti-TSH receptor antibodies of Graves' disease) has been designated as type V hypersensitivity by some authors. In addition, there are syndromes caused by massive cytokine release that are not usually referred to as hypersensitivity reactions, although (in accord with the definition) they should be included in that category. Examples are anti-CD3 mAb therapy, superantigen- (superAg) induced diseases (toxic shock syndrome, scalded skin syndrome), and shock caused by endotoxins (gram negative septicemia). Despite the occurrence of tissue injury, it should be understood that hypersensitivity mechanisms evolved as a means of fighting infectious agents. The mechanisms underlying these hypersensitivity states will be described and some clinical examples will be mentioned. In particular, the important role of cytokines, which is an area where considerable progress has occurred in recent years, will be emphasized.

scholarly journals Comparative Characteristics of Sensorimotor Reactions of Highly Qualified Athletes with Different Types of Heart Rate Regulation

2021 ◽  
Vol 6 (5) ◽  
pp. 456-464
Author(s):  
A. P. Romanchuk ◽  
◽  
O. V. Guzii ◽  
A. V. Maglyovanyi ◽  
◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Type I ◽  
Sensorimotor Function ◽  
Type Ii ◽  
Highly Qualified ◽  
Rate Regulation ◽  
Type Iv ◽  
Heart Rate Regulation ◽  
Different Types

The purpose of the study was a comparative analysis of sensorimotor reactions in highly trained athletes with different types of heart rate regulation. Materials and methods. 202 highly trained male athletes aged 22.6±2.8 years, who are engaged in acyclic sports – martial arts (karate, taekwondo, kickboxing, boxing, freestyle wrestling, Greco-Roman wrestling, judo, sambo) and games (water polo, soccer) were examined. The experience in sports was 10.3±3.1 years. All studies were conducted in the pre-competition period in the morning. Based on the study of heart rate variability in athletes, the type of heart rate regulation was determined. The basis for determining the types of regulation is the classification of heart rate variability indicators, taking into account their inclusion in certain limits. Heart rate variability indicators that reflect the dual-circuit model of heart rate regulation and are used for diagnosis include: total heart rate variability – total power (ms2), very low frequency (ms2), and stress-index (e.u.), which reflect the various chains of regulatory effects on heart rate. According to certain data types, 4 groups were formed. 1 group (type I) consisted of 42 athletes, 2 (type II) – 28 athletes, 3 (type III) – 88 athletes, 4 (type IV) – 44 athletes. The study of sensorimotor function was performed using the device KMM-3. Results and discussion. It is shown that the most balanced sensorimotor reactions are in athletes with type III regulation of heart rate. The most strain sensorimotor reactions are observed in type II regulation of heart rate, which is reflected in the pronounced central asymmetry of movement control with acceleration to the left against the background of deteriorating accuracy of right (due to flexors) and left (due to extensors) limbs, and the right-hand predominance. Sensorimotor reactions are quite strain in type IV of heart rate regulation, which is characterized by slow reactions at the synaptic and peripheral levels. In type I of heart rate regulation, the disorders observed at the central level of regulation relate to the asymmetry of short-term motor memory processes, which are significantly reduced in the left hemisphere. Conclusion. The study shows that the differences in the regulatory support of heart rate in highly qualified athletes are accompanied by characteristic differences in sensorimotor function. The latter can be useful for the diagnosis and further correction of conditions associated with the development of overexertion and overtraining

Histological Investigation of the Palatine Bone in Prenatal Trisomy 21

2001 ◽  
Vol 38 (5) ◽  
pp. 492-497 ◽  
Author(s):  
Halfdan Lauridsen ◽  
Birgit Fischer Hansen ◽  
Ingermarie Reintoft ◽  
Jean W. Keeling ◽  
Inger Kjær
Keyword(s):  
Trisomy 21 ◽  
Type I ◽  
Histological Investigation ◽  
Type Ii ◽  
Human Fetuses ◽  
Type Iv ◽  
Different Types ◽  
Horizontal Part ◽  
Palatine Bone

Objective: The purpose of the present study was to investigate the horizontal part of the palatine bone in palates from human fetuses with trisomy 21 to improve the phenotypic classification of the genotypic anomaly. Methods: Material from 23 human trisomy 21 fetuses was included in the study. The crown rump lengths of the fetuses ranged from 80 mm to 190 mm, corresponding to about 12 to 21 weeks of gestational age. The material was examined histologically. Results and Conclusions: Histological examination demonstrated four different palatal phenotypes on the basis of the development of the horizontal part of the palatine bone: type I, palatine bone complete; type II, the mesial region of the horizontal part of the palatine bone is lacking; type III, complete absence of the horizontal part of the palatine bone; and type IV, auxiliary bones in the region of the transpalatine suture. This finding shows that different types of malformations may occur in the horizontal part of the palatine bone in human trisomy 21 fetuses.

scholarly journals Hypersensitivity Reactions to Monoclonal Antibodies in Children

Medicina ◽  
2020 ◽  
Vol 56 (5) ◽  
pp. 232
Author(s):  
Francesca Mori ◽  
Francesca Saretta ◽  
Annamaria Bianchi ◽  
Giuseppe Crisafulli ◽  
Silvia Caimmi ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
Therapeutic Option ◽  
Provocation Test ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Biologic Drugs ◽  
Type Iv ◽  
Drug Provocation Test

Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.

scholarly journals Hypersensitivity Reactions Associated with Platinum Antineoplastic Agents: A Systematic Review

2010 ◽  
Vol 2010 ◽  
pp. 1-11 ◽  
Author(s):  
Nektaria Makrilia ◽  
Ekaterini Syrigou ◽  
Ioannis Kaklamanos ◽  
Leonidas Manolopoulos ◽  
Muhammad Wasif Saif
Keyword(s):  
Signs And Symptoms ◽  
Skin Tests ◽  
Type I ◽  
Platinum Compound ◽  
Hypersensitivity Reactions ◽  
Management Options ◽  
Line Setting ◽  
Chemotherapy Agents ◽  
Platinum Agents ◽  
Rule Out

Platinum-containing chemotherapy agents (cisplatin, carboplatin, oxaliplatin) have been approved in the first-line setting of numerous malignancies, such as ovarian, bladder, head and neck, colorectal, and lung cancer. Their extensive use over the last decade has led to a significant increase in the incidence of hypersensitivity reactions, which are defined as unforeseen reactions whose signs and symptoms cannot be explained by the known toxicity of these drugs. Skin rash, flushing, abdominal cramping, itchy palms, and back pain are common symptoms. Cardiovascular and respiratory complications can prove fatal. Multiple pathogenetic mechanisms have been suggested. Hypersensitivity usually appears after multiple infusions, suggesting type I allergic reactions; however, other types of hypersensitivity also seem to be implicated. Several management options are available to treating physicians: discontinuation of chemotherapy, premedication, prolonging of infusion duration, desensitization protocols, and replacement with a different platinum compound after performing skin tests that rule out cross-reactions among platinum agents.

scholarly journals Clinically significant subjective features of highly qualified athletes with different types of cardiac rhythm regulation

2021 ◽  
Vol 14 (1) ◽  
pp. 84-92
Author(s):  
O. V. Guzii ◽  
A. V. Mahlovanyi ◽  
V. M. Trach
Keyword(s):  
Cardiac Rhythm ◽  
Subjective Assessment ◽  
Type I ◽  
Highly Qualified ◽  
Type Iii ◽  
Type Iv ◽  
Heart Work ◽  
Different Types ◽  
Clinically Significant ◽  
Survey Protocol

The aim of the study is to identify the characteristic subjective features of highly qualified athletes with different types of cardiac rhythm regulation. Materials and methods. 202 highly qualified male athletes aged 22.6 ± 2.8 years and engaged in acyclic sports were examined. According to the designed survey protocol, all athletes were interviewed using a specifically designed questionnaire, which included 4 questions pools, each of them characterized certain components of athletes’ subjective assessment of their condition and attitude to it during the previous week, as well as studies using spiroarteriocardiorhythmography (SACR). Results. The SACR study allowed to divide athletes, taking into account heart rate variability (HRV) parameters, into 4 groups according to the types of their cardiac rhythm regulation. Subjective signs that might have clinical significance in the development of cardiovascular overexertion were uncomfortable sensations in the heart, feeling of interruption in the heart work, perspiration at rest, headache after sleep, perspiration at low loads, feeling of fatigue after sleep and night perspiration. Uncomfortable sensations in the heart occurred frequently in 1 % of cases and periodically in 15.3 % of cases, and feeling of interruption in the heart work occurred frequently in 0.5 % of cases and periodically in 14.9 % of cases. These indications were typical of people with cardiac rhythm regulations type I and II. In type III the least number of clinically significant features was noted. In type IV the number of significant features was less than in types I and II; however, this is nonsignificant. Probable differences in the features of perspiration at rest were noticed in athletes with type IV in comparison with type III. Conclusions. Subjective indications can be employed to verify the regulatory features of the cardiovascular system, which are associated with the centralization of effects. Questionnaires can be useful in differentiating states of overexertion according to parasympathetic type and a state of high training level in type IV cardiac rhythm regulation.

Hypersensitivity diseases

2018 ◽  
Author(s):  
Malini Bhole
Keyword(s):  
T Cells ◽  
Immune Responses ◽  
Complex Disease ◽  
Organ Damage ◽  
Type I ◽  
Hypersensitivity Reactions ◽  
Type Ii ◽  
Immune Complex Disease ◽  
Immediate Hypersensitivity ◽  
Type Iv

Hypersensitivity reactions are aberrant immune responses that are provoked by innocuous extrinsic or self-antigens, are mediated by B-cells or T-cells, and may result in tissue or organ damage. Coombs and Gell classified hypersensitivity reactions into four types, based on the different immune responses: type I, or immediate hypersensitivity; type II, or antibody-mediated (humoral) cytotoxicity; type III, or immune-complex disease; and type IV, or delayed hypersensitivity. This chapter reviews the clinical features, diagnosis, and management of hypersensitivity reactions.

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