Allergic Reactions

Frequency of Allergic or Hematologic Adverse Reactions to Ticlopidine Among Patients With Allergic or Hematologic Adverse Reactions to Clopidogrel

Allergic reaction to transfusion is common. However, the review of a large series of allergic transfusion reactions has not been performed. To review a large series of allergic transfusion reactions. A retrospective review of all reported and evaluated transfusion reactions during a 9-year period at 1 institution was performed. Associated clinical signs and symptoms were evaluated. Large, tertiary-care teaching hospital. A total of 1613 adverse reactions to transfusion were evaluated. Allergic transfusion reactions accounted for 17% (273 of 1613) of the transfusion reactions. Severe allergic reactions (anaphylaxis, anaphylactoid signs and symptoms, and/or hypotension) were observed in 21 patients (7.7% of allergic reactions, or 1.3% of all transfusion reactions). Serum tryptase, a marker for anaphylaxis, was measured in 1 patient and determined to be borderline elevated. Five patients experienced allergic transfusion reactions to autologous red cell transfusions. One patient experienced hives during the transfusion of a major ABO mismatched red blood cell. A wide variety of skin manifestations were observed, but 26 (9.5%) patients did not have skin manifestations. Allergic transfusion reactions were estimated to occur in approximately 1 in 4124 blood components transfused, or 1 in 2338 transfusion episodes. Severe allergic reactions occurred in approximately 1 in 30,281 transfusions. No deaths directly attributable to transfusion were observed in this patient group. The clinical presentation of allergic transfusion reactions was quite variable, and the pathophysiology remains unclear. Recommendations for clinical evaluation and therapy remain problematic and often empirical.

Guideline on the investigation and management of acute transfusion reactions.

Treatment of a refractory allergic reaction to a red tattoo on the lips with methotrexate and Q-switched Nd-Yag laser

IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective

Anaphylaxis to 6-α-methylprednisolone in an eight-year-old child

Abstract #1001 Background and methods
 Single reports of allergic reactions following injection of patent blue dye V - an isomer of isosulfan blue - as part of the sentinel node procedure have been well documented in small series. We report analysis from the systematic and prospective data collection of 5853 sentinel node biopsies as part of the ALMANAC trial (J Natl Cancer Inst 2006; 98(9):599-609) and NEW START sentinel node training program that has subsequently been rolled out in the UK. Prospective data collection includes documentation of side-effects after injection of patent blue dye V. The participating surgeon can specify the reaction in a free-text box. We summarised the specified reactions into local skin, allergic and cardiovascular reactions. We also charted whether the reactions necessitated any drug treatment (histamine antagonist, steroids or adrenaline / ephedrine) or triggered admission to the intensive care unit or a change of the procedure. Allergic reactions were classified into grade I (urticaria, blue hives +/- generalised rash), grade II (transient hypotension not requiring vasopressor support) and grade III (severe hypotension requiring vasopressor support).
 Results
 51 of 5853 (0.9 %) patients experienced 77 reactions to patent blue dye V. In 16 patients the type of reaction was not further specified. 5 patients were noted to have intense localised skin staining. Interestingly, 3 surgeons independently noted blue wheals distal to the blood pressure cuff. 21 patients experienced minor (grade I) allergic skin reactions. One was treated with hydrocortisone only, one with a histamine antagonist only, 6 with hydrocortison and a histamine antagonist. Grade II allergic reactions – transient hypotension not requiring vasopressor support – occurred in 4 patients, one of whom developed bronchospasm. 2 patients experienced grade III allergic reactions – severe hypotension treated with vasopressors. In 2 further patients the severity of the allergic reaction led to a change of the proposed procedure. In one patient who developed severe hypotension immediately after administration of patent blue dye V the procedure was abandoned. The patient was admitted to the intensive care unit for observation overnight but recovered without any sequelae. Another patient – who was in the ALMANAC audit phase where the sentinel node procedure was followed by the unit's conventional surgery - developed arrhythmias. The patient was meant to undergo an axillary node clearance but this was changed to axillary sampling as the final staging procedure.
 Conclusion
 Minor reactions after patent blue dye V injection are uncommon and were noted in 51 of 5853 (0.9 %) sentinel node biopsies. Severe allergic reactions requiring either vasopressor support or a change / abandoning of the procedure are even rarer - 4 of 5853 (0.07 %) procedures. It is, however, important that surgeon, anaesthetist and the unit are prepared for this eventuality. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1001.

Analysis of Allergic Transfusion Reactions at a Children's Tertiary Care Center

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

INTRODUCTION. Allergic drug reactions in hospitalised patients limit the opportunities for rational pharmacotherapy and increase the risk of polypharmacy due to the need for managing the patient’s condition and prescribing anti-allergic agents. An objective assessment of the prevalence of inpatient allergic drug reactions and a categorisation of medicinal products are critical for treatment adjustment and will lead to both a significant improvement in clinical outcomes for patients and a reduction in the financial burden for the healthcare system. The Global Trigger Tool (GTT) methodology is based on analysing medical records and capturing specific triggers, which makes the GTT easily applicable in clinical practice.AIM. This study aimed to investigate the applicability of the GTT in studying the prevalence of allergic drug reactions in patients admitted to a multidisciplinary hospital.MATERIALS AND METHODS. This study used the GTT in retrospective pharmacoepidemiological analysis of medical records of patients admitted to City Clinical Hospital 24 of the Moscow City Health Department from 1 October 2022 to 1 April 2023. The study included medical records of patients treated in the internal medicine and surgery departments during the specified period and excluded those of allergology patients.RESULTS. A total of 8,934 patients were admitted to the internal medicine and surgery departments during the analysed period. Triggers suggestive of allergic drug reactions were identified in 229 (2.6%) of their medical records. This would correspond to a prevalence of 2,563 cases per 100,000 patients. However, the analysis of prescriptions, diary cards, and clinical and laboratory findings identified only 52 (22.7%) true triggers of allergic drug reactions. In the remaining 177 (77.3%) cases, the triggers were classified as false positives, as anti-allergic agents were prescribed before or concomitantly with the suspected medicinal product, presumably, to prevent potential allergic reactions. The main groups of medicinal products suspected to cause allergic reactions were systemic antimicrobial agents (22 (40.7%) products, in particular, 14 (20.3%) beta-lactam antibiotics) and monoclonal antibodies (21 (38.9%) products).CONCLUSIONS. The true prevalence of allergic drug reactions was 0.58%, which corresponds to 582 cases per 100,000 patients. The study demonstrated the effectiveness of the GTT in identifying allergic drug reactions in real-world clinical practice. The exclusion of false triggers, first of all, anti-allergic agents prescribed as prophylaxis, significantly reduces the bias in estimating the true prevalence of allergic drug reactions and the risk of overdiagnosis.

A practical approach to immunization in atopic children.

Rashes pose a unique challenge to general internists. Here we present a case of a 51-year-old female with end-stage renal disease (ESRD) on peritoneal dialysis who presented to a General Internal Medicine clinic with a vesiculobullous rash on palms and soles 6 months after using icodextrin dialysate, a widely used osmotic agent in peritoneal dialysis. The investigations were positive for an elevated eosinophil count, elevated IgE level and a skin biopsy consistent with an allergic reaction. Her symptoms and labs normalized after stopping icodextrin. There are some reports of allergic reactions to icodextrin which usually occur within a month of initiation of the agent and are self-limiting. Here we hope to report a case of a reaction that occurred 6 months after using icodextrin.
 Resume
 Les éruptions cutanées posent un défi particulier aux internistes généraux. Nous rapportons ici le cas d’une femme de 51 ans atteinte d’insuffisance rénale terminale (IRT), sous dialyse péritonéale, qui se présente à une clinique de médecine interne générale avec une éruption cutanée vésiculo-bulleuse sur les paumes et la plante des pieds. Depuis six mois, la patiente utilise un dialysat d’icodextrine, un agent osmotique largement utilisé en dialyse péritonéale. Les analyses ont révélé une numération élevée des éosinophiles, un taux élevé d’IgE et une biopsie cutanée a indiqué la présence d’une réaction allergique. Les symptômes et les résultats d’analyses se sont normalisés après l’arrêt de l’icodextrine. Des réactions d’allergie à l’icodextrine ont déjà été rapportées, mais celles-ci surgissent habituellement dans le mois suivant le début de l’usage de l’agent et se résorbent d’elles-mêmes. Nous désirons signaler un cas de réaction survenue six mois après le début de l’utilisation de l’icodextrine.
 
 

Context.-Allergic reaction to transfusion is common. However, the review of a large series of allergic transfusion reactions has not been performed. Objective.-To review a large series of allergic transfusion reactions. Design.-A retrospective review of all reported and evaluated transfusion reactions during a 9-year period at 1 institution was performed. Associated clinical signs and symptoms were evaluated. Setting.-Large, tertiary-care teaching hospital. Results.-A total of 1613 adverse reactions to transfusion were evaluated. Allergic transfusion reactions accounted for 17% (273 of 1613) of the transfusion reactions. Severe allergic reactions (anaphylaxis, anaphylactoid signs and symptoms, and/or hypotension) were observed in 21 patients (7.7% of allergic reactions, or 1.3% of all transfusion reactions). Serum tryptase, a marker for anaphylaxis, was measured in 1 patient and determined to be borderline elevated. Five patients experienced allergic transfusion reactions to autologous red cell transfusions. One patient experienced hives during the transfusion of a major ABO mismatched red blood cell. A wide variety of skin manifestations were observed, but 26 (9.5%) patients did not have skin manifestations. Allergic transfusion reactions were estimated to occur in approximately 1 in 4124 blood components transfused, or 1 in 2338 transfusion episodes. Severe allergic reactions occurred in approximately 1 in 30281 transfusions. No deaths directly attributable to transfusion were observed in this patient group. Conclusions.-The clinical presentation of allergic transfusion reactions was quite variable, and the pathophysiology remains unclear. Recommendations for clinical evaluation and therapy remain problematic and often empirical.

Three cases of suspected sugammadex-induced hypersensitivity reactions

Toxic and allergic drug reactions during the treatment of tuberculosis