History Of Drug Allergy Research Articles

Skin testing - A valued tool for assessing adverse reactions to anaesthetic agents in patients allergic to multiple drugs: A case report from a secondary-level hospital.

Patients with allergy to multiple drugs who have experienced anaphylaxis multiple times present a significant challenge in perioperative management. This report presents a 27-year-old female patient diagnosed with cholelithiasis scheduled for cholecystectomy. The patient has a history of adverse reaction to multiple drugs, including Amoxicillin/Clavulanic acid, Cefpodoxime, Levofloxacin and two additional drugs (one analgesic and the other multivitamin) each resulting in symptoms suggestive of anaphylaxis on separate occasions. However, the patient has demonstrated tolerance to Amikacin and Paracetamol on several occasions. Given the patient's drug hypersensitivity state, the patient's anaesthetist sought clearance for use of anaesthetic drugs and disinfectants prior to surgery. Comprehensive skin testing was conducted for the same, and all drugs tested negative. The outcomes of this testing guided the selection of anaesthesia agents, ensuring safe perioperative care. Subsequently, surgery was performed, using Succinylcholine, Propofol, Rocuronium, Atropine and Neostigmine for general anaesthesia and Chlorhexidine for disinfection, and the postoperative period was uneventful. This case highlights the significance of preoperative assessment and drug testing in patients with a history of drug allergies or anaphylaxis to multiple drugs, to prevent any perioperative complications.

Empowering Pediatricians With Direct Penicillin Challenges: A Promising Delabeling Strategy.

Current literature supports a multidisciplinary approach to penicillin allergy delabeling. Our study aims to review the success rate of penicillin challenges performed at Walter Reed National Military Medical Center Allergy Clinic and assess the reaction rate associated with a direct oral challenge in low-risk patients. We conducted a retrospective review of the outcomes of pediatric penicillin challenges at the Walter Reed National Military Medical Center Allergy and Immunology clinic from June 2019 to May 2023. A total of 74 challenges were included in this study. Patients were initially screened to assess the date of reaction, nature of reaction, if the reaction was life-threatening, and if the patient was hospitalized or sought emergency medical care for the reported reaction. After completion of the screening questionnaire, a direct graded challenge was performed (without skin testing) if a patient's history was deemed low risk. Patients with a recent reaction or a history of multiple drug allergies were more likely to be directed to skin prick testing and intra-dermal testing with Pre-pen and Penicillin-G prior to challenge. All patients passed all challenges. Thus, there was a 100% pass rate for both direct challenges and skin test with oral challenges. Given the low rate of adverse events in this study, expansion of penicillin delabeling in the primary care setting should be considered in patients deemed to be at low risk. It is important for allergists to empower and educate their peers and push forward a movement to create a multidisciplinary approach to penicillin delabeling.

Epidemiological investigation of allergic rhinitis in children aged 6-12 years in Bayannur City, China.

Allergic rhinitis (AR) is an inflammatory condition of the nasal mucosa triggered by exposure to non-harmful substances. Over the past decade, the prevalence of AR in Chinese children has been steadily increasing. However, detailed epidemiological data on AR in children from Bayannur City are lacking. This study randomly selected six primary schools in Bayannur City. Electronic questionnaires were distributed via the web, and parents and children completed the questionnaires by scanning the two-dimensional code within a designated timeframe. Statistical analysis was performed on the collected data. A total of 4,754 valid responses were obtained. The self-reported prevalence of AR among children in Bayannur city was 39.79%. Multivariate analysis revealed that male gender, belonging to an ethnic minority, a history of food or drug allergies, frequent antibiotic use (≥3 times per year in the past two years, with each course lasting ≥3 days), and residence in urban or pastoral areas was associated with an increased prevalence of AR in children. The proportion of children experiencing moderate to severe AR hat impacted their studies or daily life was 48.78%. Chronic AR was reported in 56.71% of cases. Among AR patients with other allergic conditions, the incidence rates were as follows: bronchial asthma 35.99%, upper airway cough syndrome (UACS) 64.32%, secretory otitis media (SOM) 22.41%, obstructive sleep apnea hypopnea-syndrome (OSAHS) 49.58%, allergic dermatitis (AD) 48.72%, and allergic conjunctivitis (AC) 85.20%. The prevalence of AR was 50.30% in urban areas, 13.733% in rural areas and 20.90% in pastoral areas. Seasonal effects on AR prevalence were notably significant in urban and pastoral regions. The prevalence of AR among children in Bayannur city was 39.80%. Of those with AR, 48.72% experienced significant impacts on their learning or daily life, while only 14.80% had no other allergic conditions. There were significant variations in the prevalence and onset of AR among children between urban, agricultural and pastoral areas.

Cardiovascular comorbidities among patients with psoriasis: a national register-based study in China

This study aims to illustrate epidemiology of comorbid CVD in the real-world clinical setting of patients with psoriasis in China. We used data of adult patients with psoriasis who were registered in the register of China National Clinical Center for Skin and Immune Diseases between August 2020 and September 2021. Psoriasis was clinically diagnosed following the national guidelines. Univariate and multivariate logistic regression models were used to examine the factors associated with comorbid CVD in patients with psoriasis. Of the 11,560 psoriasis patients (age ≥ 18 years, mean age 41.87 years, 64.88% males), 236 were ascertained with CVD, with the overall prevalence being 2.62%. Multivariate logistic regression analysis suggested that the odds ratio (95% confidence interval) of CVD in psoriasis patients was 2.27 (2.03–2.54) for older age (per 10-year increment), 0.65 (0.48–0.90) for female, 2.07 (1.39–3.06) for obesity (BMI ≥ 28 vs. < 24 kg/m2), 2.55 (1.85–2.52) for smoking, 7.63 (5.86–9.94) for hypertension, 4.27 (3.76–4.85) for diabetes, 1.14 (1.00–1.30) for having a history of drug allergy, 2.27 (1.61–3.20) for having family history of psoriasis, and 1.76 (1.16–2.67) for severe disease (severe vs. mild) with a dose–response relationship (Ptrend < 0.001). In patients with psoriasis, comorbid CVD was associated with smoking, obesity, hypertension, diabetes, history of drug allergy, family history of psoriasis, and the psoriasis severity.

Patients' Identification, Management and Prevention of Adverse Drug Reactions: A Cross-Sectional Survey of Patients with Severe Adverse Drug Reactions.

Background: Few studies have been conducted on how patients identify, manage, and prevent severe adverse drug reactions (ADRs). This study aimed to explore the reasoning that patients use to identify symptoms of severe ADRs and the methods they employ to manage and prevent them. Methods: A cross-sectional survey using structured telephone interviews was administered to patients with a self-assessed severe ADR and to patients with serious skin ADRs from a hospital medical record database (in-patient and out-patient) from 1 September 2016 to 1 September 2019. Patients identified via the medical records were asked to assess their ADR for severity, and only patients that rated their ADR as severe were followed up with a telephone interview. Structured telephone interviews were conducted with respondents by a research pharmacist and audio-recorded. Results: A total of 722 patients with a severe ADR were identified, with 300 completing the interview (41.6%). The most frequently cited reasons for classifying ADRs as severe was worsening ADR symptoms (58.3%), severe ADR symptoms (44.4%), and ADR symptoms interfering with their life (36.4%). Only severe ADR symptoms were significantly different between the questionnaire and the medical records database groups (p = 0.007). The most frequent method of ADR management was discontinuation of drug by physicians (88.3%). About 79.0% of patients stated that they increased their carefulness when using other drugs after experiencing ADRs. The main method patients used to prevent ADRs was informing healthcare professionals (HCPs) about their drug allergy history (65.7%). Conclusions: Worsening ADR symptoms were often used to identify severe ADRs. However, HCPs were mainly responsible for the management and prevention of severe ADRs. Increasing awareness of ADRs by HCPs, and providing additional drug information, may improve patient safety.

A qualitative study exploring how undergraduate pharmacy students undertake a drug allergy history

Abstract Introduction If antimicrobial resistance (AMR) is not controlled, a post-antibiotic era could result in common infections and minor injuries becoming fatal. One way to combat AMR is the ‘de-labelling’ or removal of incorrect antibiotic allergy labels. At least 92% of labels corresponding to penicillin allergy are incorrect when tested.[1] This means that patients may not be receiving the correct antibiotic treatment and take longer to recover. Therefore, taking an accurate allergy history is important. Pharmacists routinely take drug allergy histories. From 2026, pharmacy students in England will graduate as prescribers, highlighting the importance of drug allergy knowledge and skills. Aim To explore how undergraduate pharmacy students undertake a drug allergy history. Methods A qualitative study utilising a constructivist approach involving a low-fidelity simulation followed by a one-to-one face-to-face semi-structured interview was conducted. Final year undergraduate Master of Pharmacy students of an English school of pharmacy were recruited via email and word-of-mouth to take part in this study. Following informed consent, participants simulated taking a drug allergy history with a student researcher. The simulation was audio-recorded and then played back to the participant as a cue for a subsequent audio-recorded semi-structured interview that explored their thought-process when taking a drug allergy history. All audio-recordings were transcribed verbatim. Transcripts were analysed using reflexive thematic analysis.[2] Results Nine participants took part in the study. The simulation and interview lasted seven minutes on average. Four themes were generated through the analysis. Theme 1: taking drug allergy history is learnt mainly through practice-based learning. Theme 2: nature, type and severity of allergic reactions information were deemed important for making clinical judgements. Theme 3: skills for taking drug allergy history are underdeveloped despite having knowledge. Theme 4: real patient contact exposure is needed to translate learning into practice. Most participants remembered learning about taking drug allergy history through practice-based learning sessions such as workshops, objective structured clinical examinations (OSCEs) and hospital placements. Participants seemed to follow a set of ‘rules’ when undertaking the simulation. For example, they stopped asking questions about allergies and decide not to dispense penicillin when they were informed that the patient was allergic to penicillin. Most participants recognised the risk of serious harm to patients if they made a mistake about patient allergies, and the need to have more real-world experiences to help translate their learning into practice. Conclusion Pharmacy students appeared to have the theoretical knowledge about drug allergies, but they were not yet able to make an appropriate clinical judgement in real-world situations. An increase in real-world clinical experience such as patient consultations in work-based placements can provide pharmacy students with valuable opportunities. By knowing how to undertake an accurate allergy history, fewer people will be inaccurately labelled as allergic, promoting antimicrobial stewardship. To our knowledge, this is the first study investigating how United Kingdom undergraduate pharmacy students undertake a drug allergy history. Our participants studied in one pharmacy school and undergraduate pharmacy students studying in other pharmacy schools may have different experiences around drug allergy history taking.

Retrospective analysis of perioperative anaphylactic shock induced by cefuroxime

This study investigated the characteristics and frequency of perioperative anaphylactic shock induced by cefuroxime, so as to provide a reference for the safe and rational use of cefuroxime in the perioperative period. Cases of perioperative anaphylactic shock caused by cefuroxime in our hospital from 2011 to 2021 were extracted from the Adverse Drug Reaction Monitoring System. Literature reporting adverse drug reactions (ADR) including cefuroxime-induced anaphylactic shock in perioperative settings was collected from the CNKI, VIP, Wanfang, PubMed, and Web of Science databases from their respective inception to May 2022. Statistical analysis was performed for all cases of cefuroxime-induced perioperative anaphylactic shock. A total of 31 patients were included [13 men (48.1%) and 14 women (51.9%)], most of whom were over 60 years old (n=16, 59.3%); 9 (29.0%) patients had a history of drug allergy; 5 (16.1%) patients had received skin tests, but with negative results; 28 (90.3%) patients received treatment intravenously; 22 (71.0%) patients were treated after anesthesia. For 20 (64.5%) patients the ADR occurred within 10 minutes after anesthesia. The main manifestations were hypotension, dyspnea, rash, and tachycardia. For all patients, symptoms resolved after withdrawal of the drug and active rescue, and there were no deaths. A history of allergy and skin test findings may have limitations in predicting perioperative anaphylactic shock caused by cefuroxime; greater vigilance should be exercised when using cefuroxime in the perioperative period. Close monitoring is recommended for patients undergoing treatment with cefuroxime. Rescue therapy should be administered for allergic shock, and suitable response measures must be taken in a timely manner to ensure the safety of patients.

The Determinants of Eosinophilia in Patients With Severe Asthma.

Asthma is defined by the Global Initiative for Asthma (GINA) as a heterogeneous disease characterized by chronic airway inflammation. The pathogenesis of the disease is better understood with the comprehension of immunological pathways. These pathways differ by the type of recruited cells and released interleukin (IL). Thus, asthma can be classified into subtypes based on the underlying immune mechanism: eosinophilic asthma (EA) and non-eosinophilic asthma (NEA). Patients with EA tend to respond better to inhaled corticosteroid as compared to those with NEA. The distinction of EA is very important in the light of emergent type 2 inflammation targeted therapies. We performed a 1-year (2018) retrospective cohort analysis of the Nationwide Inpatient Database (NIS). We included all adult patients presenting with severe asthma. Patients were stratified into two groups: eosinophilic severe asthma and non-eosinophilic severe asthma. The primary outcomes measures were the prevalence of chronic steroid use, status asthmaticus, family history of asthma, food, drug and environmental allergies, presence of nasal polyps, allergic rhinitis, allergic dermatitis, need for mechanical ventilation, need for oxygen supplementation, gastroesophageal reflux disease, in-hospital mortality, and length of stay. We performed descriptive statistics. Continuous parametric variables were reported using a mean and standard deviation. Continuous nonparametric variables were reported using a median and interquartile range. To compare the characteristics of the two groups, we used the independent t-test for continuous parametric variables and the Mann-Whitney U test for continuous nonparametric variables. The Chi-square test was used to assess differences in categorical variables. A total of 2,646 patients were included, out of which 882 belonged to the eosinophilic group and 1,764 were in the non-eosinophilic group. Comparing EA versus NEA, we have found that eosinophilic group was characterized by higher percentage of steroid use (18.3% vs. 9.5%, P < 0.001). This group also had higher rates of status asthmaticus and positive family history (P = 0.009 and 0.004, respectively). The presence of allergies, allergic rhinitis, nasal polyps, and allergic dermatitis was higher among patients with eosinophilia. The need for mechanical ventilation and supplemental oxygen was also higher among this group (P < 0.001 for both); however, there was no significant difference in mortality rate (P = 0.347) and the length of hospital stay was similar in both groups (P < 0.001). We showed herein that the eosinophilic subtype of asthma differs widely from the non-eosinophilic phenotype. Clinically, patients with eosinophilia might exhibit different symptomatology, more atopy, and concomitant comorbidities. However, this group might have better response to steroid therapy and might benefit from the new emergent T2 immune targeted therapy. The identification of EA is crucial for better disease control.

Do Nurses Follow The “Right Response”? Mixed Methods Research

Aim: Drug administration and management is an important procedure among clinical nursing practices and is one of the significant indicators affecting patient safety and quality of care. It was aimed to determine the nurses' monitoring of drug effects after drug treatment.&#x0D; Methods: In the study, sequential explanatory design from exploratory and mixed research methods was used. Quantitative data were collected using a data collection form and qualitative data were collected through in-depth and individual interviews using a semi-structured interview form. The interviews were recorded with a voice recorder.&#x0D; Results: It was determined that the average age, working years, weekly working hours, and daily number of patients cared for by the nurses were respectively 30.46±6.96, 7.1±6.31, 44.92±5.71, 15.42±11.89 years. It was found that 54.2% of the nurses checked the drug package insert before administering the medication, 74.5% of the nurses always considered the history of drug and food allergy to be of vital importance before drug administration, and 97.9% of the nurses reported unexpected side/toxic effects. As a result of in-depth interviews with the nurses participating in the study, three themes were identified: the approach of right drug administration principles, the approach of following the right response, and the follow-up status of nurses after drug administration.&#x0D; Conclusion: In the study, it was determined that nurses lacked knowledge about the right to correct medication, and could not implement the right to correct response due to high workload, low number of nurses and lack of time. It was observed that nurses gave the responsibility of correct response follow-up to the patient or the patient's relatives. By evaluating the reasons for not implementing the right to correct response, it is recommended that the number of nurses should be increased, the workload should be regulated, and nurses should receive training on correct drug administration and especially on the importance of correct response. It is also recommended that nurses receive training and counseling on their duties, authorities and responsibilities.

(034) Two Thousand Two Hundred Patients Treated with Collagenase Clostridium Histolitycum Collagenase in a Single Centre

Abstract Introduction Peyronie's disease (PD) is a common condition which results in penile curvature making sexual intercourse difficult or impossible. Collagenase clostridium histolyticum (CCH) is the first licensed drug for the treatment of PD and is indicated in patients with palpable plaque and curvature deformity of at least 30° of curvature. Objective To evaluate the results of a group composed of 2200 patients treated with clostridium histolyticum collagenase from December 2016 to March 2023, in a single European center. Methods We proceeded to review the database of 2200 patients diagnosed with PD with the aim of evaluating the efficacy of the treatment, number of injections performed, side effects in the short and long term, comorbidities of the patients, use of anticoagulants, onset of the disease, repercussions on the partner, satisfaction with the result; both objectively with calculation of curvature improvement, and subjectively, with improvement of the patient's clinical picture. All the patients performed a self-photograph in erection before the treatment and at the end of the same, with calculation of the curvature using a goniometer to evaluate the objective improvement, they also answered a simple question on the improvement (YES-NO) for the subjective picture. Patients were classified as mild if &amp;lt; 30° degrees; moderate 30°-60° and severe if &amp;gt; 60° according to Kelami's classification. 55 The protocol we followed was that of 3 applications 36–60 days apart according to the Ralph protocol used in Europe with the possibility of performing 1 to 3 treatments based on the efficacy of the drug, adverse events and costs. Results We evaluated 2200 patients of mean age 54.3 (range 15–77), with partners of mean age 49.8 (range 18–67). Of these, 154 (7%) had curvature less than 30°, 1320 (62%) had curvature between 30–60 degrees, and 726 (33%) had curvature &amp;gt;60°.As regards the stage of the disease, 726 (33%) had an active disease that arose for &amp;lt; 12 months, the remaining 1474 (67%) had a disease in the stabilized phase &amp;gt; 12 months. As regards comorbidities, 1276 patients (58%) were without any, 308 (14%) were hypertensive in pharmacological therapy with 1–3 drugs, 110 (5%) diabetic in therapy; of these 418 patients, 65 (2.95%) had both pathologies; 44 patients (2%) had Dupuytren's disease; 110 (5%) benign prostatic hypertrophy; 88 (4%) prior history of penile trauma with hematoma; 66 (3%) prior congenital curved penis. A further 6% other pathologies. Regarding the outcomes, 1474 (67%) showed an improvement in curvature of 10–30 degrees; 325 (14.7%) despite not having had an improvement in curvature reported that they were satisfied with the treatment. 1799 (81.8%) patients were satisfied with the treatment against 401 (18.2%) in which there was no subjective or objective improvement. With regard to complications, 946 (43%) presented slight edema/hematoma that resolved itself in the 48 hours following treatment, in 25 (1.1%) patients a major hematoma was reported which resolved in 1–2 weeks, in 1 single patient, equal at 0.04%, initial allergic reaction resolved with medical therapy based on cortisone and antihistamines (the patient reported a history of drug allergies). Conclusions Peyronie's disease remains a syndrome yet to be classified as the exact etiology and pathophysiology is not known. The only treatment approved by both the FDA and the EMA is CCH which can improve curvature by about 20 degrees. In expert hands, the possible complications are exclusively the hematoma. The satisfaction of the patient and of the partner is extremely high, the cost and the difficult availability outside the USA remain the two weak points of the treatment. These data, which certainly represent the largest case series in the world, highlight the need to re-evaluate all the literature on the subject of comorbidities and confirm that collagenase is today the gold standard of treatment which probably cannot follow pre-established therapeutic schemes, but the therapy must be set on the basis single patient. Disclosure No.

Local anesthetics allergy in children: Evaluation of diagnostic tests with Real-Life data.

Local anesthetic (LA) drugs are commonly used in clinical practice to provide effective analgesia, including in dentistry and minor surgical procedures. The perception of a high risk of allergy in daily applications leads to the referral of atopic patients and those with other drug allergies to allergy clinics for the evaluation of allergic reactions to LA. The aim of this study was to determine who should be referred to the allergy clinic for LA allergy testing, assess the frequency of LA allergy in pediatric patients, and identify the negative predictive value of skin tests in diagnosis. January 2017-July 2023, the clinical and laboratory data, as well as the results of drug allergy tests, of patients referred to our pediatric allergy clinic by dentists and physicians performing minor surgical procedures with suspected LA allergy were retrospectively evaluated. Our study included a total of 153 patients, comprising 84 girls (54.9%) and 69 boys (45.1%), with a mean age of 8.9 (±3.3) years. The most common reason for referral was a history of non-LA drug allergies (n = 66, 43.2%), followed by asthma (n = 25, 16.3%). Hypersensitivity reactions (HRs) with LA were most commonly associated with articaine (n = 7, 4.8%), followed by lidocaine (n = 6, 4.1%). When intradermal tests were evaluated, 17 patients (11.1%) had a positive test result. The positivity for lidocaine was 70.6% (n = 12), and prilocaine was 29.4% (n = 5). Subcutaneous provocation was administered to 109 patients (71.2%), and one patient exhibited local erythema and swelling with prilocaine. Although LA allergy is a rare occurrence, consultations of this nature are frequently requested from allergy clinics in real life. Considering the negative predictive value of skin tests performed with LA drugs, the reaction rate appears to be low in patients with atopy or other drug allergies. It is crucial for all relevant healthcare professionals to be knowledgeable about the appropriate approach to suspected LA allergies to avoid unnecessary tests. To the best of our knowledge, our study is the most comprehensive work in the literature that evaluates the results of diagnostic tests in children referred with a suspicion of LA allergy.

Feasibility of a drug allergy registry-based excipient allergy database and call for universal mandatory drug ingredient disclosure: the case of PEG.

Excipient allergy is a rare, but potentially lethal, form of drug allergy. Diagnosing excipient allergy remains difficult in regions without mandatory drug ingredient disclosure and is a significant barrier to drug safety. To investigate the feasibility of a drug allergy registry-based excipient database to identify potential excipient culprits in patients with history of drug allergy, using polyethylene glycol (PEG) as an example. An excipient registry was created by compiling the excipient lists pertaining to all available formulations of the top 50 most reported drug allergy culprits in Hong Kong. Availability of excipient information, and its relationship with total number of formulations of individual drugs were analysed. All formulations were checked for the presence or absence of PEG. Complete excipient information was available for 36.5% (729/2,000) of all formulations of the top 50 reported drug allergy culprits in Hong Kong. The number of formulations for each drug was associated with proportion of available excipient information (ρ = 0.466, p = 0.001). Out of 729 formulations, 109 (15.0%) and 620 (85.0%) were confirmed to contain and not contain PEG, respectively. Excipient information was not available for the other 1,271 (63.6%) formulations. We were unable to confirm the presence or absence of PEG in any of the top 50 drug allergy culprits in Hong Kong. In countries without mandatory drug ingredient disclosure, excipient databases are unlikely able to identify potential excipient allergy in drug allergy patients. Legislations to enforce mandatory and universal ingredient disclosure are urgently needed.

Incidence, predictors, and treatment outcomes of biphasic anaphylaxis in the emergency department of a tertiary hospital:A 5-year retrospective study.

Biphasic anaphylaxis despite successful treatment has an incidence of 4-5% based on NIAID/FAAN criteria. Our study aimed to investigate the frequency and predictive factors associated with biphasic reactions within the emergency department (ED) at Siriraj Hospital. This observational study assessed medical records of anaphylaxis and anaphylactic shock patients at Siriraj Hospital's ED from January 2015 to December 2019. Of these, a random sample was reviewed and validated by allergists. Telephone interviews were performed to collect more data. Uni- or biphasic response were analyzed descriptively. Prediction modeling was performed. Among 1888 ED anaphylaxis cases, 601 were randomly sampled; 239 patients completing interviews were analyzed. The incidence of biphasic reactions was 7.1% (17/239) of cases. Common triggers of biphasic responses were foods (57.7%), drugs (31%), other known allergens (5.9%). Shellfish, edible insects, and wheat were the leading food triggers. Biphasic responses were significantly associated with history of drug allergy, any allergic disease, allergic rhinitis, number of prior anaphylactic reactions, angioedema, less generalized erythema, less reaction to shellfish, reaction to NSAIDs, and no epinephrine giving at ED visit (all p < 0.1). From a 3-predictor prognostic model including drug/idiopathic reaction, duration from onset to first epinephrine > 60 minutes, and any cutaneous edema/angioedema with an area under the curve of 0.72 (95%CI 0.54, 0.90). The incidence of biphasic response was 7.1%. Predictors of biphasic response were drug/idiopathic reac- tion, any cutaneous edema/angioedema, and time from onset to first epinephrine > 60 minutes.

Prevalence and Risk Factors of Allergic Rhinitis; A systematic Review

Allergic rhinitis (AR), an immunoglobulin E-induced nasal infection, significantly impacts nasal mucosa function and quality of life. Its incidence has risen globally, showing variations across income categories. This systematic study aimed to determine the prevalence and risk factors of AR. Data were sourced from PubMed/Medline, Scopus, and Embase, following PRISMA guidelines. English-language articles (2010–2023) discussing AR prevalence and risk factors were included. A total of 15 articles were reviewed, with surveys and national database analyses being predominant (n=15). The search initially yielded 95 studies, of which 15 met inclusion criteria. Enhanced knowledge of prevalence and risk factors is crucial for future treatment improvements. The prevalence of AR has surged, necessitating evidence-based assessments of risk factors. For adults, risk factors include smoking, asthma, family history of AR, drug and food allergies, pollen allergy history, antibiotic use, occupational dust exposure, home renovation, and middle school education. In children, passive smoking, asthma, family history of AR, allergies, eczema, pet ownership, seafood consumption, male gender, and breastfeeding were identified as risk factors. The study highlights AR prevalence\&amp;apos;s correlation with allergic diseases, familial allergy history, and environmental factors. Comprehending these associations is pivotal for enhancing adherence to preventive management plans.

Hereditary Angioedema- A Rare Case Report and Literature Review

Hereditary angioedema (HAE) is a rare disorder due to either deficiency or dysfunction of Complement 1 (C1) esterase inhibitor (C1-INH). HAE usually presents with recurrent angioedema (AE) episodes affecting the extremities, face, and gastrointestinal tract, but it is not associated with urticarial rash and itching. Timely identification of this condition is vital because the lack of response to traditional antihistamines and steroids leads to a rise in mortality of up to 30%–40% in undiagnosed cases. Here, we present a case involving a 25-year-old woman, who presented with 1-day complaints of right upper limb swelling, which spread to involve all the limbs and her face within 12 h of symptom onset. She also had a history of abdominal pain, which was sudden in onset, squeezing type, without any associated vomiting and diarrhea. She denied a history of drug or food allergies. Given the presence of AE, we treated her with antihistamines and steroid injections, but she failed to respond. On asking, she gave a history from childhood of repeated episodes and similar complaints in her family members. With history and physical symptoms suggestive of HAE, diagnostic studies showed decreased complement 4 l (C4) and C1 INH levels, confirming the diagnosis of HAE Type 1. The patient was successfully managed with fresh-frozen plasma as first-line treatment options are unavailable in India. Due to a lack of clinical awareness, the disease often remains undiagnosed for several years. Thus, there is a high need to raise clinical awareness and diagnostic facilities to improve case detection and management of HAE.

Hypersensitivity Reactions to Taxanes: A Multicenter Study for Outcomes and Safety of Rapid Drug Desensitization.

Taxanes can cause hypersensitivity reactions (HSRs), which pose a significant challenge in the treatment of malignancies. Patients who are eligible for rapid drug desensitization (RDD) can continue treatment; however, some patients experience breakthrough reactions (BTRs). Data about risk factors for BTRs during RDDs in patients with HSRs to taxanes are limited. This was a multicenter, retrospective study of patients with immediate-HSRs to taxanes. Initial HSRs were classified as grade 1, 2, or 3 based on severity. Prick/intradermal skin tests were performed with implicated taxanes. A 12-step protocol was used during RDD. The study comprised 75 patients (F/M: 63/12, mean age 49.92 ± 11.72 years, 43 HSRs to paclitaxel, 32 HSRs to docetaxel). The majority of reactions (86.7%) occurred during the first or second exposure. The prevalence of drug allergy history was higher in patients with paclitaxel HSR than in those with docetaxel HSR, although it was not statistically significant (23.3% vs. 6.3%). The initial HSRs were mostly grade 2 (n = 50, 66.7%) or grade 3 (n = 22, 29.3%). Skin tests with implicated taxanes were done on 48 patients, and the rate of positive response in patients with grade 1, 2, and 3 initial HSRs were 50%, 17.6%, and 16.7%, respectively. . A total of 255 RDDs were completely performed, although BTRs occurred in 27 (grade 1, 55.6%; grade 2, 40.7%; grade 3, 3.7%). There were no statistically significant correlations between the risk of BTR and age, drug cycle, gender, positivity of skin test or atopy. The step reduction was successfully done on 9 eligible patients with mild or moderate HSRs during the 12-step RDDs. Our experience demonstrates a 100% success rate in completing the 255 RDDs for taxanes, affirming the safety and efficacy of the RDD within the study population.

Evaluation of risk factors for recurrence of cutaneous adverse reactions due to anti-seizure medications in children: A retrospective study.

Background: Cutaneous adverse reactions (CARs) are one of the most important reasons for anti-seizure medication (ASM) discontinuation in epilepsy. However, such discontinuations can cause an increase in seizures. This study investigates the risk factors for ASM-related rash recurrence in children. Methods: This retrospective case-control study consisted of the patient group with a single rash due to ASMs (group 1), the patient group with rash recurrence (group 2), and the control group. While the demographic and clinical features of group 1 and the control group were compared in terms of a single rash, group 1 and group 2 were compared for rash recurrence. Results: Group 1, group 2, and control group consisted of 112, 33, and 166 patients, respectively. Female gender was a risk factor for a single rash (P < 0.001) but not for recurrence (P = 0.439). Presence of atopic disease [odds ratio (OR): 9.5, 95% confidence interval (CI): 3.8-23.1, P < 0.001], family history of drug allergy (OR: 26.3, 95% CI: 9.6-72.1, P < 0.001), and polytherapy (OR: 23.5, 95% CI: 8.7-62.9, P < 0.001) were risk factors for rash recurrence. Aromatic nature of both the ASMs associated with the first rash (OR: 14.4, 95% CI: 3.2-63.2, P < 0.001) and rash recurrence (OR: 11.3, 95% CI: 4.6-27.5, P < 0.001) were determined as risk factors separately. Conclusion: Careful use of aromatic drugs may prevent recurrence of ASM-related CAR in children, particularly in cases of personal history of allergic disease and family history of drug allergy.

Prior drug allergies are associated with worse outcome in patients with idiosyncratic drug-induced liver injury: A machine learning approach for risk stratification

The impact of prior drug allergies (PDA) on the clinical features and outcomes of patients who develop idiosyncratic drug-induced liver injury (DILI) is largely unknown. We aimed to assess the clinical presentation and outcomes of DILI patients based on the presence or absence of PDA and explore the association between culprit drugs responsible for DILI and allergy. We analysed a well-vetted cohort of DILI cases enrolled from the Spanish DILI Registry. Bootstrap-enhanced least absolute shrinkage operator procedure was used in variable selection, and a multivariable logistic model was fitted to predict poor outcomes in DILI. Of 912 cases with a first episode of DILI, 61 (6.7%) had documented PDA. Patients with PDA were older (p = 0.009), had higher aspartate aminotransferase (AST) levels (p = 0.047), lower platelet count (p = 0.011) and higher liver-related mortality than those without a history of drug allergies (11% vs. 1.6%, p < 0.001). Penicillin was the most common drug associated with PDA in DILI patients (32%). A model including PDA, nR-based type of liver injury, female sex, AST, total bilirubin, and platelet count showed an excellent performance in predicting poor outcome in patients from the Spanish DILI Registry (area under the ROC curve [AUC] 0.887; 95% confidence interval [CI] 0.794 – 0.981) and the LATINDILI Network (AUC 0.932; 95% CI 0.884 – 0.981). Patients with suspected DILI should be screened for PDA as they would require a close monitoring for early detection of worsening clinical course.

Comparison of the General Characteristics of Patients with Severe Asthma Who Switched from Omalizumab to Mepolizumab versus Patients Who Responded to Omalizumab Treatment: A Real-Life Study

Introduction: Severe asthma is characterized by frequent recurrent airway symptoms and exacerbations, and these affect the quality of life. Biological agents can be used in the treatment of patients with severe asthma if the disease cannot be controlled with standard controller treatment. The aim of this study was to compare the clinical characteristics and laboratory data of patients with severe asthma who were switched from omalizumab to mepolizumab and patients with severe asthma who responded to omalizumab. Methods: The clinical characteristics and laboratory data of patients with severe asthma who responded to omalizumab and switched from omalizumab to mepolizumab were compared retrospectively. Results: Evaluation was made of a total of 79 patients, including 64 omalizumab responders and 15 who switched to mepolizumab from omalizumab. After omalizumab and mepolizumab treatment, the annual number of asthma attacks, the use of oral corticosteroid (OCS), the annual number of hospitalizations, and the eosinophil count significantly decreased (omalizumab: p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively; mepolizumab: p = 0.001, p = 0.001, p = 0.002, p = 0.001, respectively). After omalizumab treatment, the increase in forced expiratory volume in 1 s (FEV1) (%) and asthma control test (ACT) score were determined to be statistically significant (p < 0.001, p < 0.001, respectively). After mepolizumab treatment, the increase in ACT score was significant (p = 0.003). Drug allergy, chronic sinusitis with nasal polyps (CRSwNP), regular use of OCS, and high baseline eosinophil count (cells/µL) were associated with poor response to omalizumab treatment (odds ratio [OR] = 7.86, p = 0.003; OR = 52.92, p < 0.001; OR = 10.16, p = 0.004; OR = 0.99, p = 0.004, respectively). House dust mite sensitivity and high baseline FEV1 (%) were associated with good response to omalizumab treatment (OR = 0.29, p = 0.041; OR = 1.06, p = 0.03, respectively). The blood eosinophil count had diagnostic value in predicting the nonresponsiveness to omalizumab treatment (area under the curve [AUC]: 0.967, p < 0.001, cut-off: 510). Conclusion: A high pretreatment eosinophil count, concomitant CRSwNP, a history of drug allergy, and regular OCS use may be associated with poor response to omalizumab treatment in patients with severe asthma. Depending on the treatment response, treatment switching can be applied between biological agents. The results of the current study should be supported by multicenter studies.

Ironing out the Wrinkles: Low Molecular Weight Iron Dextran and Premedications

Intravenous (IV) iron infusion increases hemoglobin levels and reduces the need for transfusions compared to oral iron in patients with iron deficiency. Low molecular weight iron dextran (LMW ID) has a boxed warning for anaphylactic-type infusion reactions and premedication is commonly given. However, a recent multi-institution cohort study showed similar rates of infusion-related adverse events (AEs) with iron sucrose (4.3%) and iron dextran (3.8%), and a 23-fold higher incidence of AEs among those who received premedication compared with those who did not (38.6% vs 1.7%). There is currently a national shortage of iron dextran. A study during a previous iron dextran shortage in 2016 showed that the increased use of newer IV iron formulations persisted even once the shortage ended. This may in part be due to the concern for infusion reactions, but the use of these formulations comes at a significant cost. An analysis of the US FDA database showed that, based on differences in the average price of iron sucrose and LMW ID, the cost to prevent one life-threatening AE related to the use of LMW ID was estimated to be 5.0-7.8 million dollars. The cost to prevent one LMW ID-related death was estimated to be 33 million dollars. To further evaluate the incidence of infusion reactions and the use of premedication at the University of Kansas Medical Center, we performed a retrospective analysis of all patients who received their first ever infusion of iron dextran between 1/1/2021-12/31/2022. Infusion reactions were characterized as severe if hypoxia (O2&amp;lt;90%), hypotension (&amp;lt;100/80) or hospital admission occurred. Ninety-six patients were identified. 17 (17.7%) were males and 79 (82.3%) were females. There were 49 (51%) Caucasian, 26 (27.1%) African Americans, 12 (12.5%) Hispanic, and 9 (9.4%) others. 8 patients had infusion reaction (8.3%; 95% CI 4.0-15.1%) as determined by review of nursing documentation. Serious infusion reactions with LMW ID were rare (n=2, 2.1%), and neither patient required epinephrine administration nor hospitalization. Patients with history of allergies (n=61, 63.5%) had a higher incidence of AEs compared to those who did not (13.1% [95% CI, 6.4-23.2%] vs 0.0%, P = 0.022). This was even higher in 27 (28.1%) patients with 3 or more allergies (18.5% [95% CI, 7.4-35.9%] vs 0.0%, P = 0.019). In 71 (80.2%) patients who received premedication, there was a lower incidence of AEs compared to those who did not (3.9% vs 26.3%; χ2 = 10.02; P =0.007). The incidence of AEs was compared with individual premedication, and lower incidences were seen in 64 (66.7%) patients with diphenhydramine (3.1% vs 18.8%, χ2 = 6.82; P =0.015), 50 (52.1%) with methylprednisolone (2.0% vs 15.2%, χ2 = 5.48; P =0.022), and 46 (47.9%) with acetaminophen (0.0% vs 16%, χ2 = 8.03; P =0.004). Notably, a variety of premedication combinations and doses were used, indicating a lack of standardization even within a single institution. No patient who received acetaminophen experienced an infusion reaction. By contrast, there was no significant difference in patients receiving famotidine, suggesting that while acetaminophen may be a useful premedication, famotidine may not be beneficial. Further, our data strongly suggests that patients without a history of drug allergies do not require premedication. Our retrospective study demonstrates significant benefit to receiving premedication, which is divergent when compared to previous studies. This may be due to several reasons: the previously mentioned multi-center study included multiple formulations of IV iron, had a much lower rate of premedication (6% vs. 80%), and used a different definition of infusion reaction. In the multi-center cohort study, administration of medications post-iron infusion was used as a surrogate marker of reaction, while in our study it was based on review of nursing documentation. Both our study and the prior multi-center study noted an increased incidence of infusion reactions in patients with a history of allergies, and both demonstrated the rarity of serious reactions. Based on these results and the prior studies indicating the increased cost of other IV iron formulations, consideration of reinstitution of LMW ID with de-escalation of premedication in those without history of drug allergies should be considered once the current drug shortage resolves.