Incidence Of Cross-reactivity Research Articles

Facing Hymenoptera Venom Allergy: From Natural to Recombinant Allergens.

Along with food and drug allergic reactions, a Hymenoptera insect Sting (Apoidea, Vespidae, Formicidae) is one of the most common causes of anaphylaxis worldwide. Diagnoses of Hymenoptera venom allergy (HVA) and specific immunotherapy (SIT) have been based on the use of crude venom extracts. However, the incidence of cross-reactivity and low levels of sensibility during diagnosis, as well as the occurrence of nonspecific sensitization and undesired side effects during SIT, encourage the search for novel allergenic materials. Recombinant allergens are an interesting approach to improve allergy diagnosis and SIT because they circumvent major problems associated with the use of crude venom. Production of recombinant allergens depends on the profound molecular characterization of the natural counterpart by combining some “omics” approaches with high-throughput screening techniques and the selection of an appropriate system for heterologous expression. To date, several clinically relevant allergens and novel venom toxins have been identified, cloned and characterized, enabling a better understanding of the whole allergenic and envenoming processes. Here, we review recent findings on identification, molecular characterization and recombinant expression of Hymenoptera venom allergens and on the evaluation of these heterologous proteins as valuable tools for tackling remaining pitfalls on HVA diagnosis and immunotherapy.

Prediction of Potential Cross‐reactivity Between β‐Lactam Antibiotics and Anti‐benzylpenicillin Serum Antibodies

The phenomenon of cross-reactivity between β-lactam antibiotics and anti-antibodies raised in-vivo against a previously administered β-lactam antibiotic, is believed to be a major factor underlying the incidence of immunologically mediated adverse reactions, principally hypersensitivity type reactions and as such possess a significant problem when it occurs frequently with pharmaceutically administered compounds, such as the β-lactam antibiotics. Assessment of the physicochemical and structural properties of the 31 β-lactam antibiotics in conjunction with the levels of cross-reactivity with anti-benzylpenicillin serum antibodies, using the dedicated computational and statistical methods of QSAR, has enabled the development of three statistically significant and predictively valid models which relate the incidence of cross-reactivity to specific physicochemical and structural properties common to the β-lactam antibiotics, and which can be used to predict the potential cross-reactivity of untested or hypothetical β-lactams with anti-benzylpenicillin serum antibodies.

Cephalosporin use in treatment of patients with penicillin allergies

ObjectiveTo review the evidence that supports the use of certain cephalosporins in penicillin-allergic patients. Data sourcesPublished articles were identified through Medline and EMBASE (1960–2007) using the search terms penicillin and allergy and cephalosporin and cross-reactivity. Additional sources were identified from the authors' personal collection and the reference bibliographies. Study selectionThe articles found in the search were limited to the English language and screened for relevance. Review articles and republication of results were excluded. A total of 44 articles reported evidence of cross-reactivity between cepha- losporins and penicillins in human and animal studies. Additional references provided background and perspective. Data synthesisPhysicians may now prescribe certain cephalosporins in patients with a history of a nonserious, non-life-threatening penicillin reaction. Exclusions include type I anaphylaxis, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, and other potentially life-threatening responses to medication. Recent reports demonstrate that a considerable body of literature describing the cross-reactivity between cephalosporins and penicillin was established based on nonallergic adverse reactions or in vitro studies rather than on clinically relevant immune-mediated reactions. Oral rechallenge and skin testing data support the relationship of the beta-lactam side-chain structures of these drugs as a predictor of cross-reactivity. ConclusionRecent data suggest that the incidence of cross-reactivity among penicillins and cephalosporins is lower than historically reported. Pharmacists should be aware that cephalosporin cross-reactivity in a penicillin-allergic patient is not necessarily a class effect. Dispensing should be evaluated based on the type of allergic manifestations and the drug prescribed.

Prophylactic subconjunctival cefuroxime during cataract surgery in patients with a penicillin allergy

The incidence of cross-reaction after subconjunctival cefuroxime following cataract surgery in penicillin allergy patients is not common and therefore cefuroxime with its better spectrum of action and lower toxicity is probably a better choice than gentamycin.

Cross-Reactivity of Beta-Lactam Antibiotics

During a drug history, the most common drug allergies cited are those experienced after the administration of a penicillin, with a reported allergy incidence of 1% to 10% in patients who receive drugs in this class (1). Penicillins, as well as other beta-lactam antibiotics such as cephalosporins, carbapenems, and monobactams, contain a beta-lactam ring (2). The safety of administering beta-lactam antibiotics to penicillinallergic patients is highly debated and is based mainly on anecdotal information regarding the incidence of cross-reactivity. Another factor complicating safety is the validity of the reported allergy. For example, patients experiencing gastrointestinal upset with penicillin administration often mistakenly report this reaction as an allergy on subsequent interview. In addition, <20% of patients who report penicillin allergies have a positive result when given a penicillin skin test (3). However, Preston et al studied the accuracy of self-reported penicillin allergy at their institution (1). Patients enrolled in the study were determined to be allergic or intolerant through an interview conducted by a pharmacist. Of the 117 patients enrolled in the study who reported having a penicillin allergy, the majority (82.9%) were classified as having a true allergy, and 17.1% were classified as intolerant. The purpose of this paper is to discuss the available data concerning the safety of administering cephalosporins, carbapenems, and monobactams to penicillin-allergic patients.

Incidence of imipenem hypersensitivity reactions in febrile neutropenic bone marrow transplant patients with a history of penicillin allergy.

The purpose of this retrospective study was to assess cross-hypersensitivity between imipenem/cilastatin and penicillin in patients with reported penicillin allergies. Medical records of febrile neutropenic, penicillin-allergic bone marrow transplant recipients who received imipenem/cilastatin treatment were retrospectively reviewed. The findings of this study indicate the incidence of cross-reactivity between imipenem/cilastatin and penicillin among patients with a history of penicillin allergy may be lower than previously reported.

Heparin-induced thrombocytopenia: cross-reactivity between standard heparin, low molecular weight heparin, dalteparin (Fragmin) and heparinoid, danaparoid (Orgaran).

The incidence of cross-reactivity between unfractionated heparin and LMWH, fragmin, in patients with HIT is significantly lower (6/15, 40%) than hitherto reported in the literature. 7/9 patients with a negative cross-reactivity test were treated with dalteparin sodium (Fragmin) without any untoward events.

Identification of heterologous monoclonal antibodies that cross-react with cervine leukocyte subpopulations

The degree to which cross-reactivity between monoclonal antibodies developed against cells of the human, mouse, bovine and ovine immune systems, and cells of the cervine immune system occurs was investigated. It was found that within the ruminants a considerable degree of cross-reactivity does exist while there is virtually none between the cervine and murine or human systems. The highest incidence of cross-reactivity was found between ovine monoclonals and cervine leukocytes (46% cross-reactive) with 25% of bovine monoclonal antibodies cross-reacting with deer leukocytes. Ovine monoclonals were found to be the most useful in identifying a wide range of cervine leukocyte subpopulations. Bioassays showed that ovine anti-class I and II monoclonals detected molecules on cervine leukocytes that are functionally similar to MHC antigens. The possibility that cross-reactive monoclonals detect similar subpopulations in both the homologous and heterologous species is discussed.

Radioimmunuassay compared to thin-layer and gas--liquid chromatography for detecting methadone in human urine.

Radioimmunoassay was compared to thin-layer and gas--liquid chromatographic methods for detection of methadone in the urine of patients undergoing methadone maintenance therapy as treatment of heroin abuse. With urine samples known to contain methadone, 84% were positive by thin-layer chromatography as compared to 99% positives by the other two methods. This difference is attributed to the difference in sensitivity of the three methods. All three methods gave consistently positive results with urine samples from patients receiving 25 mg of methadone per day or more. With smaller daily doses the percentage of positive results obtained with thin-layer chromatography decreased. Analysis of urine samples not containing methadone showed no incidence of cross reaction of other drugs with the methadone radioimmunoassay. The methadone radioimmunoassay appears to be both sensitive and reliable; however, certain other factors limit its use as a primary screening method.