Management Of Hypersensitivity Reactions Research Articles

Cefotaxime-induced allergic reaction in a 4 years old boy: Case presentation and management strategies

The present case study aims to report and analyze a hypersensitivity reaction to cefotaxime in a 4-year-old boy, highlighting the clinical presentation, diagnostic investigations, management, and classification of the adverse drug reaction using established systems. Cefotaxime, a third-generation cephalosporin, is a semisynthetic antibiotic derived from "cephalosporin-C," produced by the fungus . A 4-year-old boy weighing 15 kg presented with a high-grade fever, cold, loss of appetite, and general weakness. He was admitted with a provisional diagnosis of Acute Febrile Illness (AFI) and initiated on parenteral cefotaxime (750 mg BD), along with paracetamol and febrinil. On the second day of therapy, he developed a hypersensitivity reaction characterized by a rash, prompting the discontinuation of cefotaxime. He was treated with antihistamines and hydrocortisone and switched to intravenous amikacin (100 mg BD). The Widal test was positive for antigen O++, with elevated C-reactive protein levels (1.86 mg/dl). Other tests, including dengue, urine analysis, and complete blood count, were within normal limits except for a slight elevation in white blood cells (8.62×10^9/L). Adverse drug reactions (ADRs) to cefotaxime can be classified using the Rawlins-Thompson and DoTS systems. The Rawlins-Thompson system categorizes ADRs into Type A (predictable pharmacological effects) and Type B (unpredictable and serious). The DoTS system considers dose relatedness, timing, and patient susceptibility, providing a comprehensive framework for understanding drug reactions. This case of cefotaxime-induced hypersensitivity falls under Type B in the Rawlins-Thompson classification and is characterized by the DoTS system. Clinicians should be vigilant for ADRs with cefotaxime, despite its general safety. Prompt recognition and management of hypersensitivity reactions are essential to prevent further complications. Discontinuing the offending agent and providing appropriate supportive care is crucial for patient recovery.

Radiographers’ confidence in handling iodine based contrast media hypersensitivity reactions

IntroductionAdverse reactions to iodinated contrast media, which is used during computed tomography (CT) examinations, are rare. As a result, radiographers have limited experience handling those situations and may feel uncertainty and a lack of confidence. The aim of this study was to investigate radiographers' confidence in handling hypersensitivity reactions to contrast media during CT examinations. MethodsA survey in the form of a questionnaire was conducted to gather both quantitative and qualitative data. There were 31 clinics that participated in this study, of which four were university hospitals, 17 were medium-sized hospitals and 10 were small hospitals. In total, the questionnaires were distributed to 700 radiographers. The questionnaire contained 12 questions and was distributed via email with a link to the questionnaire. ResultsTwo hundred-ninety radiographers participated in the survey. 72% of the respondents answered in the middle of the four-point scale (2–3) in response to the statement “I feel confident in handling hypersensitivity reactions”. 65% answered that they did not have routines for training regularly regarding hypersensitivity reactions. Qualitative data showed that many of the respondents wished to receive education and training regularly. ConclusionsThe confidence of radiographers regarding the management of hypersensitivity reactions was deficient and most of the respondents wished they felt more confident. Implication for practiceTo increase radiographers' confidence in handling hypersensitivity reactions, it is recommended that the radiology clinics review their routines and the possibility to implement regular training.

Characteristics and management of hypersensitivity reactions with rabbit anti-thymocyte globulin in pediatric patients.

Background: Anti-thymocyte globulin (ATG) has been successfully used for decades to prevent graft versus host disease before hematopoietic stem cell transplantation (HSCT) as a part of conditioning regimen. However, sometimes hypersensitivity reactions may limit its use. Objective: To evaluate hypersensitivity reactions experienced during rabbit-ATG infusion among children and present successful desensitization protocol. Methods: The medical records of pediatric patients who were given rabbit-ATG treatment at our tertiary center hospital HSCT unit between 2019 and 2022 were reviewed retrospectively. Diagnosis of the patients, age at the time of HSCT, gender, presence of hypersensitivity reaction to rabbit-ATG, and management were evaluated. Characteristics of the reaction and presence of hypersensitivity reaction to other drugs were also noted. If performed, desensitization protocols were evaluated retrospectively. Results: We evaluated 81 patients; 66.6% of them (n = 54) were boys. The mean age of the patients was 8.78 ± 5.48 years. Hypersensitivity to rabbit-ATG was seen in six patients (7.4%). Four of them (4.9%) had anaphylaxis; two (2.4%) had urticaria. Intradermal test performed to every patient before the first dose of ATG infusion was detected a positive result in 1 patient (1.2%) . None of these seven patients had allergic reactions to other drugs before. Successful ATG desensitization was performed in five patients by using a 12-16 step protocol due to patients' reaction severity. Conclusion: This study aimed to evaluate hypersensitivity reactions with rabbit-ATG in children. A successful desensitization protocol with rabbit-ATG is presented. Desensitization must be performed with an experienced team very carefully in the absence of alternative drug.

Hypersensitivity Reactions to Components of Cardiac Implantable Electronic Devices and Their Treatment: A Systematic Review.

Background: Hypersensitivity reactions (HSRs) to components of cardiac implantable electronic devices (CIEDs) are rare but difficult to differentiate from device infection. Data on best management strategies of HSRs to CIEDs are lacking. The aims of this systematic review are to summarise the available literature on the aetiology, diagnosis and management of HSR in CIED patients and to provide guidance on best management strategies for these patients. Methods and results: A systematic search for publications on HSR to CIED in PubMed from January 1970 to November 2022 was conducted, resulting in 43 publications reporting on 57 individual cases. The quality of data was low. The mean age was 57 ± 21 years, and 48% of patients were women. The mean time from implant to diagnosis was 29 ± 59 months. Multiple allergens were identified in 11 patients (19%). In 14 cases (25%) no allergen was identified. Blood tests were mostly normal (55%), but eosinophilia (23%), raised inflammatory markers (18%) and raised immunoglobulin E (5%) were also encountered. Symptoms included local reactions, systemic reactions or both in 77%, 21% and 7% of patients, respectively. Explantation of CIED and reimplantation of another CIED coated with a non-allergenic material was usually successful. Use of topical or systemic steroids was associated with high failure rates. Conclusion: Based on the limited data available, the treatment of choice for HSRs to CIEDs is full CIED removal, reassessment of CIED indication and reimplantation of devices coated in non-allergenic materials. Steroids (topical/systemic) have limited efficiency and should not be used. There is an urgent need for further research in this field.

Classification and management of hypersensitivity reactions

An inappropriate or excessive immune response to an antigen that has unfavourable effects is referred as a hypersensitivity reaction. People who have experienced at least one prior exposure to the antigen are more likely to have the symptoms. Nearly 60 years ago, Gell and Coombs first classified hypersensitivity reactions into four broad categories. Many forms of hypersensitivity reactions frequently occur at the same time, especially in allergic disorders. The purpose of this research is to review the available information about the classification and management of hypersensitivity reactions. Allergen-specific immunoglobulin E, which is associated with the high-affinity receptors of basophils and mast cells mediates type 1 hypersensitivity reactions. These receptors are cross-linked by allergens, which release mediators that elicit urticaria, angioedema, and anaphylaxis. Immunoglobulin G and immunoglobulin M attach to self-antigens on cell surfaces in type II reactions, which can lead to phagocytosis, and cytotoxicity that is complement-directed and antibody-dependent all of which can lead to tissue damage. Immune complexes of immunoglobulin G and immunoglobulin M with antigens, which deposit in tissues and directly harm organs, mediate type III reactions. T cells mediate type IV reactions which are delayed responses. In every case of allergic hypersensitivity, the trigger must be stopped right away. Antihistamines, glucocorticoids, and epinephrine are used to treat acute responses Some potential management techniques include drug allergy testing, graded challenges, desensitization, and/or choosing an alternative, non-cross-reactive substance. Further clinical research is however needed for the elaborated study of hypersensitive reactions and development of preventive strategies.

Hypersensitivity reactions to biologics in children

ABSTRACT Introduction Hypersensitivity reactions (HSRs) have been observed with the use of biologics in children. The management of HSRs in children is mainly based on experiences from the adult population. Recently, data from different centers experienced in managing these reactions, including desensitization in children, have been published, allowing clinicians to have an appropriate global overview and compare results. Areas covered This review highlights the published data on hypersensitivity reactions to biologics in children and drug desensitization protocols adapted to the pediatric population. Expert opinion With regard to HSRs to biologics in children, few data are available. Compared with the adult population, there is a lack of knowledge in the endophenotypes, management and the standardization of protocols including premedication regimens in children. An international consensus is needed to provide clinicians with new insight on how to apply personalized management and to perform tailored desensitization protocols in pediatric populations. Various specialists including allergists, pediatricians, oncologists, hematologists, rheumatologists, and pharmacists, should build a multidisciplinary management team to keep pediatric patients on their best treatment options in the safest manner.

Safe Handling of Antineoplastic Drugs During Allergy Diagnostic Workup and Desensitization: A Single Experience of the Allergy Department in a Tertiary Hospital

The increased use of antineoplastic drugs has been associated with a rising number of hypersensitivity reactions to these drugs, which has led to a growth in the demand for assistance from allergy services. The involvement of an allergist is essential to ensure that these patients with hypersensitivity reactions continue to be able to receive appropriate first-line treatment. Chemotherapy and biological agents have specific handling requirements and all the allergy departments involved in the diagnosis and therapeutic management of patients reacting to these drugs should find the means to guarantee safety. There are currently several guidelines on the safe handling of hazardous drugs for healthcare workers. However, specific recommendations are lacking for reducing occupational exposure in staff working in the allergy departments and managing these drugs for the diagnosis and management of hypersensitivity reactions. This review article focuses on the safe handling strategy of the allergy department in the Ramón y Cajal University Hospital and provides details of its implementation and experience over 10 years. This protocol could improve the knowledge of safe handling of antineoplastic drugs in allergy procedures.

Improving management of hypersensitivity reactions: A BC Cancer-Victoria quality improvement initiative.

230 Background: Hypersensitivity reactions (HSR) are a documented, predictable side effect of multiple chemotherapy agents. Reactions negatively affect the patient experience, increase the amount of chair time, nursing and physician resources, may result in the omission of a potentially effective cancer management tool from a patient’s treatment plan and could potentially result in death. BC Cancer is a Health Care Organization with 6 cancer centres across British Columbia, Canada. Guideline(GL)s have been developed at BC Cancer to support clinicians to manage reactions acutely and reduce the risk of reactions with subsequent cycles. A recent audit identified that the GLs were not always being followed at the Victoria Centre. Our goal was to encourage physician and nursing staff to follow GLs, which we hypothesized would result in decreased rates of HSR. Methods: Our aim was to decrease HSR to < 5% of doses delivered within 1 year at BC Cancer-Victoria. We engaged stakeholders (nursing, physicians, pharmacy, clerical staff and administration). Our change ideas improved adherence to GLs by focusing on: physician attendance and documentation, written orders for rescue medication, and rate of infusion of the chemotherapy drug rechallenge. Our interventions included: two physician-education sessions, one nursing education session, daily huddles, pre-printed order development for management of the reaction (PPOA) and prophylaxis for subsequent cycles (PPOB), and a modified clinic flow. All interventions were introduced and underwent modifications through PDSA cycles. Our family of measures were: Outcome: number of reactions, percent of reactions per dose given. Process: percent of PPO use per reaction, physician attendance and notes dictated per reaction. Balancing: physician and nursing satisfaction. We analyzed the data using quality improvement run charts and control charts. Results: After the start of our initiative, our total number of reactions displayed special cause variation, and a shift in the baseline from a mean of 11.27 HSR per month to 7.526. This change was reflected in the percentage of reactions per doses given which fell from 3.1% to 1.9%. Average percentage of dictated notes per reaction increased from 55% to 64%. Physician attendance per reaction also showed special cause variation with the average increasing from 57% to 90%. PPOA and PPOB use both increased over time. Nursing and Physician satisfaction data will also be presented. Conclusions: Our successful initiative has resulted in HSR management which more closely reflects GLs, including increased physician attendance and notes, and clear consistent written orders detailed on PPO A and B. This has led to decreased HSRs at our site, resulting in decreased resource use and increased patient safety and quality. This has provincial implications as there is the potential to spread this initiative to other BC Cancer sites.

Hypersensitivity Reactions to Vaccines: Current Evidence and Standards for SARS-CoV-2 Vaccines.

The first reports of hypersensitivity reactions following the rollout of COVID-19 vaccination programs have raised public concern. Given the recent availability and novel mechanisms of COVID-19 vaccines, there is limited data on possible hypersensitivity reactions. Although it seems rare, the incidence of anaphylaxis for approved COVID-19 vaccines has been suggested as being higher when compared to previous vaccines. Adequate risk assessment, recognition, classification, and management of hypersensitivity reactions is crucial to ensure safe immunization and avoid misinformation and vaccine hesitancy. In this review, we present an overview of the types of hypersensitivity reactions that can potentially occur due to vaccination and the possible allergenic components of COVID-19 vaccines, as well as a suggestion for causality and risk assessment for the BNT162b2, mRNA-1273 and AZD1222 vaccines.

Hypersensitivity and Chemotherapy Desensitization.

Hypersensitivity reactions (HSRs) are defined as reactions with reproducible signs and symptoms, triggered by an exposure to a stimulus at a dose tolerated by normal subjects. Although discontinuing the allergenic medication can eliminate the potential for HSRs, it can also lead to significant morbidity and mortality due to suboptimal treatment of the underlying disease. Therefore, desensitization protocols have been developed that offer a safe process that delivers full therapeutic doses in an incremental fashion without eliciting life-threatening reactions. This article uses a case study to discuss the process of chemotherapy desensitization, associated complications, and identify areas of improvement in the management of HSRs within an academic medical center. HSRs are a complex pathophysiologic response that requires an experienced oncology nurse at the bedside to manage potentially life-threatening symptoms. Thorough education and training is needed among nursing staff to manage HSRs during the chemotherapy desensitization process.

Drug desensitization in the coronavirus disease 2019 pandemic era: Local success to widespread potential

Drug desensitization in the coronavirus disease 2019 pandemic era: Local success to widespread potential

Hypersensitivity reaction after cyanoacrylate closure of incompetent saphenous veins in patients with chronic venous disease: A retrospective study

PurposeThe objective of this study was to evaluate the incidence of, the risk factors for, the nature of the disease, and the management of hypersensitivity reaction (HSR) after cyanoacrylate closure (CAC) of incompetent saphenous veins in patients with chronic venous disease. MethodsData consisting of all incompetent saphenous veins, including great saphenous veins, anterior accessory saphenous veins, and small saphenous veins, treated with CAC at Siriraj Hospital (Bangkok, Thailand) from January 2017 to December 2018 were retrospectively evaluated. ResultsA total of 126 saphenous veins, including 106 great saphenous veins (84.1%), 7 anterior accessory saphenous veins (5.6%), and 13 small saphenous veins (10.3%) of 126 limbs from 101 patients were included. A HSR occurred in 16 of 101 patients (15.8%), in 19 of 126 limbs (15.0%), and in 19 of 126 treated saphenous veins (15.0%). HSR-related erythema, itching, swelling, and pain occurred in 100.0%, 95.0%, 68.4%, and 52.6%, of HSR patients, respectively. HSR occurred 1 week after CAC. All HSR symptoms were mild, could be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamine, and were resolved within 1 week. The risk factors for HSR were suprafascial saphenous vein with a depth <1 cm from the skin, and saphenous vein diameter of ≥8 mm. ConclusionsA HSR occurred in 15.8% of patients and in 15.0% of limbs after CAC. Risk factors for HSR were a suprafascial saphenous vein located close to the skin and a large saphenous vein. All HSR symptoms were mild in severity, occurred at 1 week after CAC, and were resolved within 1 week after treatment with nonsteroidal anti-inflammatory drugs and antihistamines. To prevent HSR, CAC should be avoided in suprafascial saphenous veins that are located close to the skin, and CAC in saphenous veins with a size of ≥8 mm should be performed with caution.

Delayed hypersensitivity to antiepileptic drugs in children.

Antiepileptic drugs (AEDs) are widely used for the treatment of epilepsy, but they can be associated with the development of mainly delayed/non-immediate hypersensitivity reactions (HRs). Although these reactions are usually cutaneous, self-limited, and spontaneously resolve within days after drug discontinuation, sometime HR reactions to AEDs can be severe and life-threatening. This paper seeks to show examples on practical management of AED HRs in children starting from a review of what it is already known in literature. Risk factors include age, history of previous AEDs reactions, viral infections, concomitant medications, and genetic factors. The diagnostic workup consists of in vivo (intradermal testing and patch testing) and in vitro tests [serological investigation to exclude the role of viral infection, lymphocyte transformation test (LTT), cytokine detection in ELISpot assays, and granulysin (Grl) in flow cytometry. Treatment is based on a prompt drug discontinuation and mainly on the use of glucocorticoids. Dealing with AED HRs is challenging. The primary goal in the diagnosis and management of HRs to AEDs should be trying to accurately identify the causal trigger and simultaneously identify a safe and effective alternative anticonvulsant. There is therefore an ongoing need to improve our knowledge of HS reactions due to AED medications and in particular to improve our diagnostic capabilities.

Biological treatments in allergy: prescribing patterns and management of hypersensitivity reactions

Biological agents (BA) are emerging as potential effective treatment for allergic and hypersensitivity disorders (A/H). Four main classes of BA are now (May 2020) approved by US Food and Drug Administration and European Medicines Agency for A/H: anti-IgE (omalizumab),1 anti-IL5 (mepolizumab, reslizumab),2 anti-IL4/13 (dupilumab),3 and anti-IL5R (benralizumab).4 Hypersensitivity reactions (HSR) due to BA can occur with different severity degrees, which hamper their use. New types of HSR have been reported with lack of standardized and guided allergy workup.

Cuidados de Enfermagem no manejo de reações de hipersensibilidade em pacientes submetidos à terapêutica antineoplásica: revisão para a prática clínica

Objetivo: Identificar as evidências científicas disponíveis na Literatura acerca dos cuidados de Enfermagem aos pacientes com câncer que apresentem reações de hipersensibilidade durante o tratamento antineoplásico, e assim descrever quais são as melhores práticas para o seu manejo. Método: Revisão integrativa da Literatura operacionalizada de julho a setembro de 2019 nas bases de dados PUBMED, EMBASE, CINAHL E LILACS, a partir dos termos Oncology, drug hypersensitivity, drug therapy, nursing care. Resultados: A busca resultou em 5 estudos, que investigaram especificamente as intervenções de Enfermagem frente às reações de hipersensibilidade. Tendo como base a prática baseada em evidências (PBE), foi construído um quadro determinando as melhores práticas descritas na Literatura. Dentre as intervenções encontradas, destacaram-se: avaliação prévia do paciente, avaliação rápida do grau de reação, pausa da infusão da droga, avaliação de vias aéreas, boa respiração e circulação, administração de solução fisiológica, oxigenoterapia, corticóides e antihistamínicos conforme protocolos institucionais e avaliação contínua dos sinais vitais. Conclusão: Os enfermeiros oncológicos precisam estar devidamente capacitados para o manejo de reações de hipersensibilidade e junto à equipe médica fornecer ao paciente uma assistência rápida e precisa para minimização das complicações e agravos no decorrer do tratamento.

Oxaliplatin: Detection and Management of Hypersensitivity Reactions.

Oxaliplatin is used extensively for the treatment of gastrointestinal cancer and other malignancies, with increased frequency of use in recent years. Hypersensitivity reactions (HSRs) can pose a major problem in clinical practice because they can limit the use of oxaliplatin in the care of malignancies in which it has proven efficacy. Nurses play an integral role in the administration of oxaliplatin; therefore, they need to be well educated in the prevention, detection, and management of HSRs. This article reviews the symptoms of HSRs associated with oxaliplatin, the specific management of HSRs associated with oxaliplatin, the role of desensitization, and the potential use of skin testing to better identify patients at risk for HSR. This article reviews the literature related to the diagnosis, prevention, and management of HSRs associated with oxaliplatin and outlines nurses' role. Oxaliplatin HSRs can occur at any cycle, but patients are at highest risk after they have received six prior infusions of oxaliplatin.

Drug Hypersensitivity and Desensitizations: Mechanisms and New Approaches.

Drug hypersensitivity reactions (HSRs) are increasing in the 21st Century with the ever expanding availability of new therapeutic agents. Patients with cancer, chronic inflammatory diseases, cystic fibrosis, or diabetes can become allergic to their first line therapy after repeated exposures or through cross reactivity with environmental allergens. Avoidance of the offending allergenic drug may impact disease management, quality of life, and life expectancy. Precision medicine provides new tools for the understanding and management of hypersensitivity reactions (HSRs), as well as a personalized treatment approach for IgE (Immunoglobuline E) and non-IgE mediated HSRs with drug desensitization (DS). DS induces a temporary hyporesponsive state by incremental escalation of sub-optimal doses of the offending drug. In vitro models have shown evidence that IgE desensitization is an antigen-specific process which blocks calcium flux, impacts antigen/IgE/FcεRI complex internalization and prevents the acute and late phase reactions as well as mast cell mediator release. Through a “bench to bedside” approach, in vitro desensitization models help elucidate the molecular pathways involved in DS, providing new insights to improved desensitization protocols for all patients. The aim of this review is to summarize up to date information on the drug HSRs, the IgE mediated mechanisms of desensitization, and their clinical applications.

From the Children's Oncology Group: Evidence-Based Recommendations for PEG-Asparaginase Nurse Monitoring, Hypersensitivity Reaction Management, and Patient/Family Education.

PEG-aspariginase is a backbone chemotherapy agent in pediatric acute lymphoblastic leukemia and in some non-Hodgkin lymphoma therapies. Nurses lack standardized guidelines for monitoring patients receiving PEG-asparaginase and for educating patients/families about hypersensitivity reaction risks. An electronic search of 6 databases using publication years 2000-2015 and multiple professional organizations and clinical resources was conducted. Evidence sources were reviewed for topic applicability. Each of the final 23 sources was appraised by 2 team members. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to assign a quality and strength rating for each recommendation. Multiple recommendations were developed: 4 relating to nurse monitoring of patients during and after drug administration, 8 guiding hypersensitivity reaction management, and 4 concerning patient/family educational content. These strong recommendations were based on moderate, low, or very-low-quality evidence. Several recommendations relied on generalized drug hypersensitivity guidelines. Additional research is needed to safely guide PEG-asparaginase monitoring, hypersensitivity reaction management, and patient/family education. Nurses administering PEG-asparaginase play a critical role in the early identification and management of hypersensitivity reactions.

Evaluation of hypersensitivity reactions to oxaliplatin in gastrointestinal malignancies.

709 Background: Oxaliplatin is an important component of therapy for multiple gastrointestinal cancers. The incidence of hypersensitivity reaction (HSR) to oxaliplatin is approximately 10%, and about 3% are serious in nature (Grade 3 or 4). Data on management of hypersensitivity reactions is limited to small case series, with scarce information on the success rates of rechallenging patients who have previously reacted. Methods: We conducted a retrospective review of patients who had a documented hypersensitivity (HSR) to oxaliplatin utilizing our internal adverse event reporting system from January 1, 2007 until December 31, 2012. Results: 44 patients met inclusion criteria for this study. The majority had a grade 1 or 2 reaction (n = 36 or 81.82%). Seven patients had a grade 3 reaction and one patient experienced a grade 4 reaction. 29 patients were rechallenged with oxaliplatin during subsequent courses. Infusion durations were extended in 79% of cases, and additional premedications were administered in 90%. Two patients were treated with a desensitization protocol, which consisted of serial dilutions of oxaliplatin (given over approximately 8 hours) with a two-stage premedication regimen. With these measures, seventeen of the twenty-nine patients (66%) were able to receive 3 or more additional infusions, thirteen (45%) received 5 or more additional infusions, and 4 (14%) we able to receive 10 or more additional infusions. Conclusions: Our review of hypersensitivity reactions to oxaliplatin demonstrates that the majority of patients experience mild (Grade 1 or 2) reactions and are able to be successfully rechallenged in subsequent courses with modifications in the infusion rate and premedications. The use of these treatment strategies may prevent premature discontinuation of an important backbone drug for the treatment of gastrointestinal malignancies.

An intermediate step for the management of hypersensitivity to platinum and taxane chemotherapy.

The guideline article “Management of hypersensitivity to platinum- and taxane-based chemotherapy: cepo review and clinical recommendations” in this journal for the management of hypersensitivity reactions (HSR) to this group of chemotherapy agents is useful in clinical practice [...]