Use of Rapid Drug Desensitization in Delayed Hypersensitivity Reactions to Chemotherapy and Monoclonal Antibodies

Background:Rapid drug desensitization (RDD) allows first-line therapies in patients with immediate drug hypersensitivity reactions (DHR) to chemotherapeutic drugs (ChD) and monoclonal antibodies (mAb). Desensitization in delayed drug reactions has traditionally used slow protocols extending up to several weeks; RDD protocols have been scarcely reported.Patients and Method:We retrospectively analyzed the patients referred to the Allergy Department, who had experienced a delayed DHR (> 6 h) related to a ChD or mAb and underwent an RDD protocol. The rate of successful administration of the offending drug and the presence of adverse reactions were evaluated.Results:A total of 93 RDDs were performed in 11 patients (including 6 men and 5 women, with a median age of 61 years). The primary DHR were maculopapular exanthema (MPE) (8), generalized delayed urticaria (1), MPE with pustulosis and facial edema (1), and facial edema with desquamative eczema (1). The meantime for the onset of symptoms was 3 days (range 1–16 days). RDD was performed using a protocol involving 8–13 steps, with temozolomide (25), bendamustine (4), rituximab (9), infliximab (24), gemcitabine (23), and docetaxel (8), within 4.6–6.5 h. Sixteen breakthrough reactions were reported during the RDD (17.2 %) in 5 patients; all were mild reactions including 11 delayed and 5 immediate reactions. All patients completed their treatment.Conclusions:RDD is a potentially safe and effective procedure in patients suffering from delayed reactions to ChD and mAb. It allows them to receive full treatment in a short period, thereby reducing time and hospital visits.

Single-Dose Ibuprofen-Arginine as a Preventive for Pain, Edema, and Trismus After Impacted Lower Third Molar Surgery: A Randomized Split-Mouth Clinical Trial

Objective We examined if the association of ibuprofen with arginine has a better anti-inflammatory effect on pain, edema, and trismus after surgery of the impacted mandibular third molar than ibuprofen alone. Materials and Methods The study included 21 patients, 18 to 30 years of age, each with an impacted, and bilateral and symmetric third molar (total n = 21) that required transalveolar extraction. Patients were randomly assigned numbers from 1 to 21. Group A received ibuprofen-arginine as preoperative medication, while Group B received only ibuprofen. Both groups received the same postoperative medications: amoxicillin + acetaminophen. All patients were evaluated for pain at 6, 12, and 24 hours. They were evaluated for edema and trismus before surgery; immediately after surgery; and at 24, 48, and 72 hours postoperatively. Postoperative pain scores used the visual analog scale (BS-11). For facial edema and trismus, linear measurements used the method modified by Gabka and Matsumura. Statistical Analysis For the evaluation of data between Group A and Group B, we used the statistical software SPSS version 22. The Shapiro-Wilk, analysis of variance, the Bonferroni comparisons, and the Wilcoxon test were used. All tests were based on a significance level of 0.05. Results The study results reveal that the facial edema scores of Group A and Group B presented statistically significant differences (p < 0.05), while for postoperative trismus, there was no statistically significant difference (p > 0.05) between the scores of Group A and Group B. Conclusion As a conclusion, we can state that the use of ibuprofen-arginine allows for significantly better control of pain and edema, and shows a tendency toward better recovery from trismus, although without statistical significance. Based on this, we can assert that arginine improves the anti-inflammatory power of ibuprofen, thus generating better tissue healing after surgery of the impacted third molar.

Hydroa Vacciniforme-Like Cutaneous T-Cell Lymphoma

Hydroa vacciniforme (HV)-like cutaneous T-cell lymphoma (HVLL) is a controversial skin pathology because some cases appear as hydroa vacciniforme, whereas others progress to cutaneous T-cell lymphoma with or without angiocentricity. It is usually associated with infections of Epstein Barr viruses and NK-cell lymphomas and typically affects the pediatric population. Symptoms include facial edema, papules, vesicles, and blisters in the facial region, arms, legs, and areas exposed to sunlight that leave varioliform scars. There may be infiltration of the lips, eyelids, and nose, usually accompanied by comorbid infections and hypersensitivity to insect bites. Frequency is rare, but HVLL more commonly affects patients from South America and Asia. Its clinical management can be difficult and accompanied by a high index of malignancy, thus early diagnosis is essential for effective and timely management.

Battling the Emerging Epidemic of Rhino-Orbital-Cerebral Mucormycosis (ROCM) in COVID-19 Pandemic: A Prospective Interventional Study

Purpose: The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. Methods: This is a prospective, interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. Results: The mean age of patients was 40.45± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous amphotericin and oral posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients (P<0.01). Overall, 68.5 % responded to therapy, 8.5 % showed progression and mortality rate was 22.85 %, at a mean follow up period of 59.5 days.Conclusion: A multidisciplinary and aggressive approach is essential in the management of CAM patients.

Outcome of using plat eletrich plasma in postextractional wound treatment

Background. Platelet-enriched plasma (PRP) is a revolutionary autologous biomaterial that stimulates bone regeneration, enhances regenerative processes and postoperative wound healing, thus simplifying future implant-prosthetic rehabilitation. Objective of the study. Evaluation of PRP regeneration properties in postextractional wound regeneration. Material and Methods. The clinical examination was used as research methods: inspection, palpation, paraclinical examination: panoramic radiography / CBCT and VAS test were performed. The diagnosis and treatment plan were established, as follows: extraction associated with PRP injection. Results. At the postoperative evaluation of the patient after 7 days of treatment, the intensity of pain according to the modified VAS method showed decreased values- from 4 to 1, the postextractional wound was completely healed, the level of regeneration was attested by the absence of dehiscence, presence of the pale pink epithelium, absence of the postoperative facial edema according to the craniometric points, the Celsius signs also were absent. Conclusion. The use of PRP biomaterial in wisdom tooth extraction is a minimally invasive method of tissue regeneration that reduces the rehabilitation period and prevents the occurrence of post-extraction complications.

Resolution on the results of the Council of Experts on the Long-term Prophylaxis of Hereditary Angioedema in Russia

Hereditary angioedema (HAE) is a rare (orphan) disease associated with the development of angioedema of various localization caused by the action of bradykinin. The main symptoms of the disease are peripheral angioedema, abdominal attacks (accompanied by severe pain syndrome), edema of the upper respiratory tract, which may lead to asphyxia and death of the patient. Peripheral edema disrupts social and professional activity, the occurrence of facial edema complicates social adaptation, the unpredictability and potential threat to life of edema in the larynx, as well as the lack of effect from standard (systemic glucocorticoid and antihistamines) therapy regimens lead to a low quality of life of patients, a large number of days of disability, hospitalizations, in some cases, premature death of patients. According to international studies, "on-demand" therapy does not reduce the burden of the disease, and therefore international guidelines emphasize the importance of timely and individualized selection of long-term prevention for patients with HAE. Taking into account the appearance of a new drug for long-term prevention in Russia, an Expert Council was held to assess the burden of the disease in Russian patients, determine the proportion of patients who need long-term prevention, criteria for choosing a medication for prophylaxis and the place of Lanadelumab in it.

Eczema-like plaques secondary to enoxaparin misdiagnosed as DRESS-syndrome

Low-molecular-weight heparins may cause adverse skin reactions, especially eczematous eruptions. A 60-year-old woman with a history of mitral valve replacement and frontal hemorrhagic stroke, who had been treated with carbamazepine and enoxaparin for 2 months, consulted our department for a sudden onset of generalized pruritic rash. There was facial edema, cheilitis, and a rash of eczematous lesions electively localized to the site of enoxaparin injections. Blood analysis showed eosinophilia= 2500 e/mm3, gamma GT = 526 and lipasemia= 126. Initially we suspected the diagnosis of carbamazepine induced DRESS syndrome. Then the final diagnosis was generalized eczema on heparin in view of the exclusive localization of the lesions at the sites of enoxaparin injections, the rapid resolution of the eruption and the result of biopsy and allergological investigation. Dermatologic effects of heparins commonly used in medical and surgical practice are numerous, and clinical pictures can be misleading, as in our case.