Multiple Drug Hypersensitivity Research Articles

Is referring patients with a positive history of allergic drug reactions or atopy for allergy testing to local anesthetics justified?

Although no more than 1% of adverse reactions to local anesthetics (LA) are thought to be immunologically mediated, many patients continue to be referred to allergy clinics for allergy workup. We evaluated the impact of a history of drug hypersensitivity or atopy on results of allergy testing to LA, with the aim of determining the appropriateness of allergy testing to LA in such patients. We retrospectively analyzed medical records of 112 consecutive patients referred for allergy testing to LA in a 9-year period (1996-2005). Intradermal tests with diluted (1:10) LA were performed to identify patients at risk for immunoglobulin E (IgE)-mediated hypersensitivity reaction. The odds for being testpositive were calculated with regard to the defined risk factors (atopy, history of adverse reactions to LA or other drugs, underlying autoimmune disease). Eleven of 112 patients (9.8%) tested positive for allergy to LA. Atopy, history of adverse reactions to LA or other drugs and underlying autoimmune disease did not increase the odds for being test-positive. The prevalence of multiple drug hypersensitivity, IgE values and eosinophil count were not significantly higher among the patients who tested positive as compared to the patients who tested negative. According to our data, allergy testing to LA is not justified in patients with atopy or histories of adverse drug reactions other than to LA. Further studies using validated methods of allergy testing to LA coupled with analysis of defined risk factors are needed to definitively establish the indications for referral of patients for allergy testing to LA.

Transient Hypogammaglobulinemia After Antiepileptic Drug Hypersensitivity

The case is described of a 32-month-old male with transient but long-lasting severe hypogammaglobulinemia subsequent to multiple drug hypersensitivity. The patient had remarkably decreased immunoglobulin levels (IgG 136 mg/dL, IgA 11 mg/dL, and IgM 10 mg/dL) 3 months after hypersensitivity to phenobarbital and phenytoin. Immunological study revealed reduction of B-cell count and decreased lymphocyte proliferation response to Staphylococcus aureus Cowan. IgM secretory response to pokeweed mitogen and S. aureus Cowan was almost preserved, whereas IgG secretory response was markedly decreased. The patient was treated with intravenous immunoglobulin, although recurrent infection was not observed before treatment. His immunoglobulin levels became normal more than 5 years after the onset of hypogammaglobulinemia.