History Of Drug Allergy Research Articles

Blepharoconjunctivitis as Manifestation of Stevens-Johnson syndrome

Background: Stevens Johnson syndrome (SJS) is a collection of acute and life threatening skin symptoms caused by an allergic drug reaction. SJS also attacks the other mucous membranes, one of which is the eye. SJS is a rare case. The initial complaint of SJS is the eruption on the skin in the form of redness followed by blisters and attacking other mucous membranes. The ocular manifestations of SJS are conjunctivitis, corneal erosion, corneal ulcers, and blepharitis. Methods: Treatment of SJS’s ocular manifestation is administration of drugs and surgical intervention. Administration of drugs that often done in the acute phase is antibiotic eye drops with steroids to prevent complications. Complications that can occur include symblepharon, districhiasis, and keratitis. This complication can cause a sharp decrease in vision. Results: This case report discusses a 68 year old male patient with blisters all over his body accompanied by swelling in both eyes, redness in both eyes, and difficult to open eyes. Patients with history of taking the new drug a month ago. No history of drug allergy. The patient suffered from hypertension, non-hemorrhagic stroke, and epilepsy with irregular treatment. Patient was performed a fluorescein test. In this case, the patient is given antibiotic ointment and artificial tears with steroids. In this case there were no complications. Conclusion: The ocular manifestations of SJS if handled quickly and properly can prevent long-term complications.

Spectrum of anti tubercular therapy induced cutaneous adverse drug reactions and its management through rechallenge: A prospective study at a Tertiary Care Centre

IntroductionThe use of multi-drug regimens including 1st and 2nd line anti tubercular drugs in management of tuberculosis (TB) has been associated with undesirable adverse drug reactions including cutaneous one. Re-challenge remains the only option to restart the safe therapy and combat the tuberculous infection simultaneously. Materials and methodologyThis cross-sectional study was conducted via prospective review of outpatients as well as indoor patients who presented with cutaneous adverse drug reactions to ATT between March 2020 and March 2021. Data were analysed regarding demographic profile, site of TB, ATT regimen, pattern of cutaneous lesions, offending drugs, past history of drug allergy, and reinstitution of ATT after re-challenge. ResultsOut of total 56 registered tubercular patients presented with cutaneous adverse drug reaction 30 were females (53.57%). The most common site of TB was pulmonary followed by cervical lymph node TB. The three most common adverse drug reaction detected were maculopapular rash 32 (57.1%) followed by lichenoid drug eruptions in 6 (10.7%) and urticaria in 2 (3.6%). Ethambutol was found to be common offending drug followed by other first line anti-tubercular drugs. 5 patients developed multiple drug hypersensitivity on re-challenging and have to introduce steroids along with ATT. ConclusionAdverse cutaneous drug reactions to ATT is like a double-edged sword as stopping ATT and starting treatment with systemic steroids can further flare up the infection with increased risk of disseminated and multidrug resistant tuberculosis. Re-challenge was found out to be safest way in identifying culprit drug and hence to restart a safer alternate ATT regimen for better management.

DALES, Drug Allergy Labels in Elective Surgical patients: a prospective, multicentre cross-sectional study of prevalence, nature and anaesthetists’ approach to management

BackgroundWe sought to define the prevalence and nature of patient-reported drug allergies, determine their impact on prescribing, and explore drug allergy knowledge and attitudes amongst anaesthetists. MethodsWe performed a prospective cross-sectional study in 213 UK hospitals in 2018. Elective surgical patients were interviewed, with a detailed allergy history taken in those self-reporting drug allergy. Anaesthetists completed a questionnaire concerning perioperative drug allergy. ResultsOf 21 219 patients included, 6214 (29.3 %) (95% confidence interval [CI]: 28.7–29.9) reported drug allergy. Antibiotics, NSAIDs, and opioids were the most frequently implicated agents. Of a total of 8755 reactions, 2462 (28.1%) (95% CI: 29.2–31.1) were categorised as high risk for representing genuine allergy after risk stratification. A history suggestive of chronic spontaneous urticaria significantly increased the risk of reporting drug allergy (odds ratio 2.68; 95% CI: 2.4–3; P<0.01). Of 4756 anaesthetists completing the questionnaire, 1473 (31%) (95% CI: 29.7–32.3) routinely discuss perioperative allergy risk with patients. Prescribing habits in the presence of drug allergy labels differ depending on the implicated agent. Most anaesthetists (4678/4697; 99.6%) (95% CI: 99.4–99.8) prescribe opioids when reactions are consistent with side-effects, although 2269/4697 (48%) (95% CI: 46.9–49.7) would avoid the specific opioid reported. ConclusionsAlmost 30% of UK elective surgical patients report a history of drug allergies, but the majority of reported reactions are likely to be non-allergic reactions. Allergy labels can impact on perioperative prescribing through avoidance of important drugs and use of less effective alternatives. We highlight important knowledge gaps about drug allergy amongst anaesthetists, and the need for improved education around allergy.

COVID-19 Tanısı Olan Bir Hastada Ürtiker ve Anjiyoödem: Olgu Sunumu

Coronavirus disease 2019 (COVID-19) disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) virus, which has affected the whole world, can cause clinical pictures ranging from mild cold symptoms to severe lower respiratory tract infections that can cause mortality. Recently, reports of dermatological findings associated with COVID-19 such as urticaria has been increasing. Here, a COVID-19 case presenting with urticaria and angioedema is described. A 26-year-old female patient, who was found to be SARS-CoV-2 positive by polymerase chain reaction performed for being in contact, presented to our outpatient clinic with complaints of itchy, erythematous lesions on her body and swelling in the eyes and throat for four days. The patient received favipiravir treatment for 5 days and these complaints started 4 days after the treatment ended. History of food and other drug allergies, insect bites and chemicals were questioned in the differential diagnosis for etiology, however, no relationship was detected. Systemic corticosteroid and antihistamine treatment was initiated, and edema in the eyes completely regressed and urticaria plaques faded on the 3rd day of the treatment. Dermatological findings may occur simultaneously with the classic symptoms of the disease or before or after symptoms. Although the pathogenesis between dermatological findings and COVID-19 has not been fully elucidated, studies have suggested that viral infections and SARS-CoV-2 can be an etiological agent for chronic or acute urticaria. It is thought that some rashes may be causally related to the viral effect and others to the immune response. It is emphasized that there may be atypical findings such as urticaria/angioedema in order to diagnose COVID-19 disease early and prevent its spread and should be considered in differential diagnosis.

Epidemiological investigation of allergic rhinitis in central cities and countrysides of Inner Mongolia region

Objective: To investigate the prevalence of allergic rhinitis (AR) in 3 central cities (Chifeng, Hohhot, Ordos) and the surrounding rural areas of Inner Mongolia region, and to look for possible risk factors related to the disease. Methods: From March to October of 2019, a multi-stage stratified random sampling epidemiological survey was conducted in Chifeng, Hohhot, Ordos and rural areas. The AR-related factors of the population were obtained in the form of face-to-face questionnaire survey, and the skin prick test (SPT) was taken for the participants. AR disease was diagnosed according to the "Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (2015, Tianjin)". The daily airborne pollen situation in the three regions was monitored during the same period. SPSS 23.0 was used to analyze all survey results. Results: A total of 6 818 questionnaires were recovered, with 6 393 valid questionnaires. The self-reported prevalence of AR was 27.72% (1 772/6 393) and the confirmed prevalence of AR was 17.10% (1 093/6 393). The prevalence of perennial AR was 1.83% (117/6 393) while the prevalence of seasonal AR was 15.27% (976/6 393). The prevalence of AR diagnosed in females was higher than that in males (19.19% vs 15.34%, χ²=16.594, P<0.001) and the prevalence of females in the two age groups of 36-45 years and 46-55 years was significantly higher than that of males (18.17% vs 9.73%, 14.13% vs 7.25%, χ2 value was 23.848, 18.772, respectively, all P<0.001). The prevalence of confirmed diagnoses in ethnic minorities was higher than that of Han nationality, and the prevalence of confirmed diagnoses in urban areas was higher than that in rural areas (23.13% vs 16.20%, 27.27% vs 9.71%, χ2 value was 24.516, 336.024, respectively, all P<0.001). The main nasal symptoms of AR patients were sneezing (91.31%), nasal congestion (85.91%) and nasal itching (85.00%). The most common concomitant disease of AR was allergic conjunctivitis (73.99%). Asthma (OR=6.629), food allergy (OR=3.236), drug allergy (OR=1.786), application of antibiotics (OR=1.553), recent home decoration (OR=2.307), and smoking (OR=1.322) were the AR related risk factors. The highest proportion of SPT positive reactions was Artemisia annua (80.15%). The peak period of clinical symptoms of AR patients in Inner Mongolia region was July to September, which was consistent with the second peak period of airborne pollen monitoring. Conclusions: The prevalence of AR in central cities and the surrounding rural areas of Inner Mongolia region is 17.10%, and Artemisia species is the most important pollen allergen in this area. History of asthma, food allergy, drug allergy, antibiotic use, home decoration and smoking history are the related risk factors for AR.

THE DIFFERENCE OF RISK FACTORS OF ACUTE UPPER RESPIRATORY TRACT INFECTION IN THE URBAN AND RURAL PUBLIC HEALTH CENTER SEMARANG

Abstract Background: The acute upper respiratory tract infection was an infection on respiratory tract organ from the nose until pharynx. The geographical condition of a region could affect the case of acute upper respiratory tract infection. The factors related to both urban and rural life could affect in the difference of respiratory condition. The biological change of age, nutritional status, and allergy status were highly related to the increase of respiratory condition.Aim: To identify the risk factors of acute upper respiratory tract infection in the urban and rural public health center of Semarang.Methods: This research exerted observational research design and cross-sectional method. The total of research subjects were 200 patients with the diagnosis of acute upper respiratory tract infection in both the urban and rural public health center of Semarang. The risk factors were comprised of age, gender, body height, body weight, and history of drug allergy. The data sampling was taken through consecutive sampling technique. Moreover, the statistic test used Chi-square test.Results: This research finding referred that the largest number of sample on the age category in both urban and rural public health center were in the adult age (20-60 years old) with percentage of urban public health center (66,5%) and rural public health center (46%). The risk factor of age indicated a significant result in the urban public health center (p = 0,000) and rural public health center (p = 0,010). Next, the risk factor of gender indicated an insignificant result in the urban public health center (p = 0,391) and rural public health center (p = 0,885). Last, the risk factor of nutritional status in the urban public health center indicated an insignificant result (p = 0,094), while in the rural public health center indicated a significant result (p = 0,006).Conclusion: The risk factors of acute upper respiratory tract infection in rural public health center was different from the risk factors in urban public health center. The risk factors of acute upper respiratory tarct infection in the rural public health center were age and nutritional status, while the risk factor of acute upper respiratory tract infection in the urban public health center was age.

Role of clinical history in beta-lactam hypersensitivity.

Understand how the clinical history has been used to risk stratify patients reporting a beta-lactam allergy, both in clinical care pathways and predictive models. Drug allergy clinical care pathways have emerged as a safe and effective method of stratifying patients with a reported beta-lactam allergy into risk categories, with 'low-risk' patients able to proceed straight to direct challenges or test doses. These methods have streamlined antibiotic stewardship policies and penicillin allergy de-labeling. However, how to define 'low-risk' has been subject to much debate. New research has developed predictive models that utilize the clinical history to assess a patient's true risk of beta-lactam allergy. The clinical history has long been an essential part of drug allergy evaluation and has proven invaluable within the past decade in the development of drug allergy clinical pathways. Evidence-based predictive models that use the clinical history to assess a patient's true risk of beta-lactam allergy offer tremendous promise, but differ in crucial areas such as the populations they study, the predictor variables they use, and the ultimate accuracy they attain. These models highlight key aspects of the drug allergy history and pave the way for future large-scale research.

Profile of Determinant Factors on Drug Allergy Severity in Indonesian Children at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia

Background: Drug allergy in children is a rare case that needs special attention. Identifying the factorsthat affect the severity of drug allergy is important for the improvement of drug allergy management inIndonesian children. Objective: to analyze the factors that influence drug allergy severity in Indonesianchildren. Methods: This study used a retrospective design and consecutive sampling in 2014-2018. The datacollected included sex, types of allergy-causing drugs, previous allergy history, parental allergy history, andclinical manifestations. The data were analyzed by using a logistic regression test where the statistical testresults were significant if p &lt;0.05. Results: The average age of the participants was 93.00 ± 50.54 monthswith a median value of 84 (12 - 204) months. Drug allergy severity in children is influenced by severalthings, such as the type of drug (? = 5.76; 95% CI 1.29 - 25.70; p = 0.022), sex (? = 1.27; 95% CI 0.30 - 5.36;p = 0.743), previous allergy history (? = 2.44; 95% CI 0.10 - 58.67; p = 0.583), and a drug allergy history onparents (? = 0.65; 95% CI 0.06 - 6.75; p = 0.719). Conclusion: There is a significant relationship betweendrug allergy severity and the type of drug whereas sex, previous allergy history, and a history of allergy onparents do not find a significant connection.

Safety of COVID-19 vaccine in the patient with history of drug allergy: An issue to be monitored

Safety of COVID-19 vaccine in the patient with history of drug allergy: An issue to be monitored

Multisystem Inflammatory Syndrome in Children (MIS-C) associated with Kawasaki Disease in a three-year-old girl with SARS-CoV-2 infection

Kawasaki Disease (KD) is an acute and restrictive vasculitis. Studies have noted a viral association with the occurrence of this syndrome. This article reports a child with several severe inflammatory syndrome symptoms associated with COVID-19 and KD. The patient, a three-year-old Iranian Kurdish girl without a history of internal diseases and with no history of drug and food allergies, was referred to Imam Hasan hospital three days after diarrhea, nausea, and pain in the inner part of the left thigh. Scattered rashes around the face, neck, and arms during fever were significant. Reverse transcription polymerase chain reaction (RT-PCR) was positive for COVID-19, but the lung high-resolution computed tomography (HRCT) did not show involvement, so the diagnosis of KD associated with viral infection was suggested. In further studies, Wright and 2ME tests, Widal, and purified protein derivative (PPD) tests were declared negative. After intravenous immunoglobulin (IVIG), the patient’s fever continued, but other symptoms improved. Since COVID-19 is a new disease and our understanding of its numerous symptoms is evolving, we recommend physicians to be vigilant about secondary inflammatory syndromes that induce KD; rapid treatment with IVIG and steroids may improve patients’ conditions.

Prospective study of various methods used in the management of post partum haemorrhage

Introduction: Mismanagement of postpartum haemorrhage (PPH) is the major reason for the maternal morbidity and mortality throughout the world, highest incidence is found in developing countries. Aims and objective: To study the various methods used to control PPH in all the deliveries that took place at the study place. Materials and Methods: Prospective study was performed on 402 PPH patients in the Department of Obstetrics and Gynecology, Kamla Raja Hospital, GR Medical College, Gwalior from Sept., 2014 to Aug., 2015. All the patients were divided in to atonic PPH and traumatic PPH. Patient’s detailed history including obstetric history, menstrual history and history of drug allergy were recorded in pre-approved excel format. Patients were managed either by catheterization and uterine massage, using uterotonic drugs, uterine packing and surgical intervention such as internal iliac ligation and/or hysterectomay. Results: Out of total 7977 deliveries, 62.09% were vaginal and 37.91% were caesarean section. Out of that 402 (5.03%) developed PPH. Mean age of study population was 23.3±1.37 years. Out of 402 PPH patients, 75% were having atonic PPH whereas 19.65% were having traumatic PPH. Most of the patients with atonic PPH were managed by uterotonic drugs (69%) followed by cathererization with uterine massage (25%). Most of the patients with traumatic PPH were found to be due to hematoma or tear and were managed by haematoma drainage (58%) followed by perineal with vaginal repair (33%). Conclusion: Uterotonic drugs were the most commonly used for the management of atonic PPH whereas haematoma drainage was mostly used in patients with traumatic PPH. Keywords: Uterotonic drugs, Post partum haemorrhage, Atonic PPH, Traumatic PPH.

S1113 Risk of Idiosyncratic Drug-Induced Liver Injury Among Patients With Prior History of Drug Allergy

INTRODUCTION: Idiosyncratic drug-induced liver injury (DILI) is a rare but important cause of acute liver failure. The relationship between prior history of drug allergy and future risk of developing DILI is unknown, but some have suggested increased susceptibility. The primary aim of this study was to compare rates of DILI among patients with prior history of drug allergy versus patients without history of drug allergy. METHODS: The EMR was searched for all hospital admissions for possible DILI using ICD-10 T-codes for drug poisoning/toxicity and K-71 codes for toxic liver injury between 10/1/15 and 9/30/19. Clinically significant liver injury was defined as: 1) AST > 5 x ULN, 2) ALT > 5 x ULN, 3) ALP > 2 x ULN, 4) total bilirubin > 2.5 mg/dL, or 5) INR > 1.5. An expert opinion causality score (1/2/3 = probable-DILI, 4/5 = non-DILI), RUCAM score, and severity score were assigned to each case. Drug allergy was defined as significant adverse drug reaction such as hives, or anaphylaxis. Rates of probable-DILI among patients with prior history of drug allergy were compared to rates among those without prior drug allergy. RESULTS: Among 766,930 patients searched, 185 unique patients met inclusion criteria. After manual review of 147 cases, 37 cases of acetaminophen hepatotoxicity were excluded. In the remaining 110 cases, causality assessment identified probable-DILI in 67 patients (61%), whereas 43 (39%) had an alternative cause of liver injury, including ischemic hepatitis, and biliary obstruction. Sixty-one (55.5%) patients had history of drug allergy before DILI episode but none of the drugs was the same as those suspected for causing DILI. Compared to those without prior drug allergy, patients with prior drug allergy had a similar rate of DILI (67.3% vs. 55.7%, P = 0.24). Furthermore, the likelihood of death or liver transplantation among probable-DILI cases with prior drug allergy did not differ from those without prior drug allergy (5.9% vs. 6.1%, P = 1.0). Among probable DILI patients, the suspect drug was subsequently documented as a ‘drug allergy' in the EMR for only 24 (35.8%) patients. CONCLUSION: A prior history of drug allergy was not associated with a greater likelihood of subsequent DILI compared to other causes of acute liver injury. The low rate of suspect drug documentation as a “drug allergy” in the EMR after DILI episode may increase likelihood of inadvertent suspect drug re-challenge and adverse patient outcomes.

Comparison adductor canal block combined with local infiltration analgesia and adductor canal block alone for pain management after total knee arthroplasty

Background:Pain control after total knee arthroplasty has shown many advances; however, the optimal method remains controversial. The purpose of this present study is to assess the efficacy and safety of the addition of local infiltration analgesia to adductor canal block for pain control after primary total knee arthroplasty.Methods:This prospective randomized controlled research was conducted from January 2018 to June 2019. All the patients and their family members signed the informed consent forms, and this work was authorized via the ethics committee of Jinxiang Hospital Affiliated to Jining Medical College (JXHP0024578). Inclusion criteria were 55 years old or older, who possess the physical status I–III of American Society of Anesthesiologists, and the body mass index in the range of 18 to 30 kg/m2. Exclusion criteria were regional and/or neuroaxial anesthesia contraindications, the history of drug allergy involved in the research, neuropathic pain, as well as the chronic pain requiring opioid therapy. Seventy-two patients were divided into 2 groups randomly. Study group (n = 36) received both adductor canal block and local infiltration analgesia. Control group (n = 36) received adductor canal block alone. Primary outcome included postoperative pain score (visual analog scale 0 to 10 cm, in which 0 represents no pain and 10 represents the most severe imaginable pain). The measures of secondary outcome included the knee range of motion, opioid consumption, the hospital stay length as well as the postoperative complications (for instance, pulmonary embolism, deep vein thrombosis, and the wound infection). All the analyses were conducted through utilizing the SPSS for Windows Version 20.0.Results:The results will be shown in Table 1Table 1Comparison of outcomes between groups. .Conclusion:The study will provide more evidence on the combination use of adductor canal block and local infiltration analgesia in the treatment of pain after the total knee arthroplasty.Trial registration:This study protocol was registered in Research Registry (researchregistry5832).

A retrospective case-controlled cohort study of inpatient drug induced liver injury: the RIDDLE study.

Identification of risk factors for drug-induced liver injury (DILI) has been hindered by the unpredictable incidence and idiosyncratic nature of DILI. The aim of this study was to identify characteristic host risk factors for DILI. A retrospective cohort study was performed examining all patients admitted with a diagnosis of DILI over a 5.5-year period. Cases were compared to a control group non-exposed to DILI using propensity score-derived inverse probability weights. Patients with DILI due to alcohol or paracetamol were excluded from analysis. Seventy-two cases of DILI admitted to hospital were identified. Antimicrobials caused 56.9% of cases, with amoxicillin-clavulanate the single most common agent, responsible for 13.9% of cases. DILI cohort median age (50.2±36 years) was significantly younger than controls (65.0±38 years) (P<0.001). Pre-existing chronic liver disease (OR, 3.44; 95% CI, 1.38-8.59; P=0.008), length of stay (P<0.001) and in-hospital death (P=0.009) were more likely to be associated with DILI cases. There was no correlation with sex (OR male, 0.92; 95% CI, 0.50-1.67; P=0.78), presence of comorbid autoimmune disease (OR, 1.44; 95% CI, 0.68-3.05; P=0.35), past drug allergies (OR, 1.71; 95% CI, 0.92-3.16; P=0.09), or atopy (OR, 0.87; 95% CI, 0.42-1.82; P=0.72). Younger age and presence of chronic liver disease were associated with an admission with DILI; however, it remains difficult to predict the population at risk of DILI on clinical grounds and putative risk factors such as female gender, and history of other drug allergies and autoimmunity, were not demonstrated in this study.

Measuring the appropriateness of carbamazepine and valproic acid prescribing and utilization using a newly implemented online system in the Tabuk Region of Saudi Arabia

Epilepsy is a common neurologic disorder, which is efficiently treated with carbamazepine and valproic acid. Moreover, Saudi Ministry of Health implemented a new E-system for Poison Control Centers called Awtar to enhance technology utilization in ensuring patients’ satisfaction and to improve treatment outcomes. Therefore, we conducted this study to assess appropriateness of indication of requests and therapeutic levels of carbamazepine and valproic acid in Tabuk area, North West Saudi Arabia. This is a retrospective observational study conducted in Poison Control & Forensic Chemistry Center, Tabuk, Saudi Arabia. Patients’ data were obtained for years 2018 and 2019. The blood levels of carbamazepine and valproic acid were measured by Therapeutic Drug Monitoring (TDM) Unit. We selected patients treated with either valproic acid or carbamazepine alone without any history of drug allergy. Data of 264 patients were extracted from Awtar E-system. Serum carbamazepine levels were within therapeutic range in 114 patients (75.50%), above-therapeutic range in 13 patients (8.61%) and sub-therapeutic levels in 24 patients (15.89%). Regarding serum valproic acid, it is within therapeutic range in 62 patients (54.87%), above-therapeutic range in 11 patients (9.73%) and sub-therapeutic levels in 40 patients (35.40%). In conclusion, this study gives information about partial appropriateness of usage of carbamazepine and low level of appropriateness of valproic acid. However, more efforts are needed to improve results of appropriateness of indication of antiepileptic drugs.

Drug allergy to CFTR modulator therapy associated with lumacaftor-specific CD4+ T lymphocytes

Drug allergy to CFTR modulator therapy associated with lumacaftor-specific CD4+ T lymphocytes

Analysis of Related Factors of Adverse Transfusion Reactions

To investigate the related factors of adverse reactions of blood transfusion, and clinical precautions so as to reduce the adverse reactions. Data of 2108 patients with allogeneic transfusion in our hospital from January 2017 to June 2017 collected and analyzed. These patients received 15 244 time of blood transfusion, and 213 time of adverse reactions occurred in 178 patients in totality, the incidence is 1.4%, and there was no significant difference between the male (1.31%) and female (1.53%). The main type of transfusion reaction were allergy (73.23%), FNHTR (11.74%) and TACO (10.80%). Among all kinds of blood components, the incidence of adverse reactions of apheresis platelet transfusion was the highest (4.31%), significantly higher than that of cryoprecipitate and other blood components. The incidence rate of adverse reactions of blood transfusion in the hematopathy patients was 2.56%, significantly higher than that of immune diseases (1.48%), cancer diseases (1.28%) and other diseases (1.08%), (P＜0.01). The rate of transfusion history of apheresis platelets was 42.67% (the incidence of adverse reactions was 4.31%), significantly higher than other groups (P＜0.01); the rate of transfusion history of cryoprecipitate was 4.11% (the incidence of adverse reaction was 0.45%), significantly lower than other groups (P＜0.05). Among the disease types, the rate of transfusion history in the hematopathy patients was 48.79% (the incidence of adverse reaction was 2.56%), significantly higher than that of other groups (P＜0.01). The incidence of drug allergy in patients with the adverse reactions to blood transfusion was 11.25%, significantly higher than that of patients without adverse reactions (4.71%) (P＜0.01). The main risk factors of adverse reactions of blood transfusion are as follows: blood varieties, disease type, transfusion history and drug allergy history. For the patients with transfusion, multiple factors should be controlled, so as to reduce the adverse reactions.

Urticarial manifestation in COVID-19 infection: A case report

Background: The COVID-19 pandemic outbreak causes a worldwide health concern. As the epidemic progressed, several cutaneous manifestations are increasingly noticed; therefore, the authors hope this report will provide additional information that may benefit fellow healthcare professionals. Case report: A 45 years old Javanese female patient complained of fatigue, dry cough, dyspepsia, and reddish pruritic swelling on her face for one day. There was no fever, dyspnea, anosmia, diarrhea, or uvula, tongue, vocal cords, and the airway problem. She had no history of food or drug allergy, urticaria, other comorbidities, or any medicine consumption in the last 15 days. Facial dermatological status showed circumscribed, raised, erythematous areas of edema, slightly pruritic. Normal vital signs. Blood laboratory results: leucocyte 5.760/mL, decreased ALC 818/mL, increased NLR 5.0. Chest X-ray showed an increase in bronchovascular pattern and slight opacity on the peripheral, basal part of both hemithorax. COVID-19 rapid test was positive for IgM, and her PCR of upper-airway secretions revealed positive COVID-19 infection. The diagnoses were COVID-19 infection, dyspepsia, and urticaria. The treatments were levofloxacin, isoprinosine, chloroquine sulfate, omeprazole, fluimucyl, vitamin C, and diphenhydramine. Within three days of treatment, the urticaria started to fade off, and her overall condition improved. Conclusion: The COVID-19 poses a global challenge in the health sector, and one of its various manifestations is cutaneous symptoms. Further research is necessary to elucidate how COVID-19 triggers dermatological symptoms.

Prevalence of Bronchial Asthma among School Aged Children in Elmaraghah Center in Sohag Governorate

Abstract Background: Asthma and wheezes are the most common acute and chronic diseases in childhood. Early detection and good management of asthma is very important to reduce the risk and improve the health status of the diseased children. Aim of Study: Is estimation of asthma prevalence among school-aged children at Elmaraghah Center in Sohag Gover-norate, also to identify the role of different risk factors associated in aetiology of asthma. Patients and Methods: This cross sectional survey study, was conducted on 1796 children, (897 males and 899 females) from six to twelve years old in public primary schools in Elmaraghah center in Sohag governorate, all patient groups were exposed to questionnaire adopted from (ISAAC). Results: The prevalence of asthma between children included in the current study was (12.5%). Atopic dermatitis, food allergy, drug allergy, passive smoking and family history were related to high prevalence of bronchial asthma. Conclusion: The prevalence of asthma was 12.5%, and allergy to food and drugs is the most important risk factor of bronchial asthma.

Tu1171 INCIDENCE OF ADVERSE DRUG REACTIONS OF POLYETHYLENE GLYCOL ELECTROLYTES POWDER: THE ANALYSIS OF REPORTS IN CHINA

Since 2018, the National Medical Products Administration of China has issued a notice on the Direct Reporting of Adverse Drug Reactions (ADRs) by Marketing Authorization Holders (MAH), which has ushered in a new era in the reporting of ADRs in China. Objective: Niflec (Polyethylene Glycol Electrolytes Powder, PEG-ELP) is one of the most widely used oral intestinal lavage preparation agents in China. The purpose of this study is to analyze the incidence of Niflec ADRs reported in the database of ADR monitoring system in the first six months after the MAH reporting policy, and to evaluate the clinical safety of Niflec. The reports of ADRs caused by Niflec were screened out from the database of ADR monitoring system, and they were analyzed by gender, age, primary disease, concomitant drugs, occurrence time, history of allergy, ADR types, causality, and severity. From December 15, 2018 to June 15, 2019, thirty-two ADR cases were reported, including one serious adverse event. The adverse reactions were more in patients aged 60 and over (50.0%) and more in female (71.9%). Only one patient had a clear history of drug allergy. The main adverse reactions occurred in the gastrointestinal system (53.1%) or skin and mucous membrane (34.4%). The top three manifestations were vomiting, nausea and rash. Most of the ADRs were observed within 30 minutes after the first use, accounting for 37.5%. Concomitant drugs were taken by 9.4% of the patients. The one serious adverse event was intestinal obstruction with shock. According to Pharmaceutical DataBase (PDB) data, the market size of Niflec in China was approximately 2 million bags in the first and second quarter of 2019. The number of drug users was estimated to be 679,896. Based on the above analysis, the overall incidence of ADR of Niflec was relatively low, less than 5 per 100,000 patients. The total incidence of serious ADR was less than 1.5 per million, which was very rare. All patients recovered or improved after proper treatments. The safety of PEG-ELP is confirmed by this study. However, it is still necessary to pay attention to the correct preparation and proper use. The bowel preparation personnel should be alert to monitor ADRs, especially on patients aged 60 and over, and take corresponding measures if any of these reactions are encountered.