SUMMARYWhat is known and Objective: Prescribing sulfonamide-containing medications for patients with sulfonamide allergy continues to complicate medical decisions. We examined the cautionary recommendations in the approved drug monographs and primary literature, and formulated an evidence-based grading of cautionary recommendations for sulfonamide allergy and cross-reactivity among sulfonamide-containing medications. Methods: Drug monographs were collected from six countries and three drug compendia. Two reviewers independently extracted the data from the contraindication, warning and/or precaution sections of drug monographs. Evidence for crossreactivity was examined in the primary literature and compared with drug monograph recommendations. Consequently, medications were categorized based on the strength of recommendation and level of evidence by consensus. Results and Discussion: We identified wide variability in cautionary recommendations ranging from no warning or precaution to contraindication among the sources reviewed. The recommendations were located mainly in the contraindication section of monographs for France (65Á2%), United Kingdom (51Á9%), Italy (50Á0%), South Korea (43Á5%), United States (38Á2%) and Canada (37Á0%), whereas in drug compendia, the recommendations were found in the precaution section for Martindale (51Á4%) and Micromedex-Drugdex (33Á3%), and contraindication and precaution section for the American Hospital Formulary Service Drug Information 2010 (30Á8%). Evidence from the primary literature varied with recommendation included in drug monographs. Evidence-based categorization was carried out for 16 medications. Two sulfonamide-moiety-containing drugs were considered safe, six non-sulfonylarylamines required precaution, and eight medications from all three sulfonamide chemical classes were considered mostly unsafe.What is new and Conclusion: There are significant discrepancies in cautionary recommendations included in drug-labels and drug compendia. Statements concerning cross-reactive hypersensitivity with other sulfonamides generally suggest theoretical possibilities. The consensus evidence-based grading instrument developed may be useful for deriving cautionary recommendations for sulfonamide-allergic patients. WHAT IS KNOWN AND OBJECTIVESulfonamides were among the first synthetic antimicrobial medications to be used clinically.1 From a modern perspective, the term refers to a diverse group of drugs, all of which contain the sulfonamide functional group (-SO 2 NH 2 ). Based on the chemical structure, sulfonamides can be divided into three types: sulfonylarylamines, non-sulfonylarylamines and sulfonamide moiety-containing drugs.2 Antimicrobial sulfonamides (sulfonylarylamines) rank second to beta-lactams as the most common cause of drug allergy.1,3 Hypersensitivity reactions to sulfonamides have been documented since shortly after the introduction of sulfanilamide, 4 and they occur in about 3% of patients in the general population and 60% of patients with HIV infection. 5,6 The most...
Background The regulatory function of B cells is beginning to be understood, and several subsets of regulatory B cells have been suggested. A recent study suggested that the human B cell secreting IL-10 may have a central role in the regulatory function in immune system. However, the roles of regulatory B cells secreting IL-10 (B10 cells) was not established in rheumatoid arthritis (RA) pathogenesis. Objectives To know the exact status of IL-10+ B cells, we investigated the induction of B10 cells in the RA patients and analyzed disease activity. Methods CD19+ cells in peripheral blood mononuclear cells were purified from blood samples of RA patients and age and sex matched healthy controls, and stimulated with CD40 ligand and CpG for 48 hours. Intracellular IL-10 was analyzed using flow cytometry. Results The proportion of IL-10+ B cells to total B cells in RA patients was significantly higher than those in controls (RA, 4.44% ± 3.44% vs. healthy control 2.44% ± 1.64%, p = 0.033). However, the proportion of IL-10+ B cells to total B cells was correlated negatively with disease activity (r = –0.398, p = 0.040). Although age was correlated with IL-10+ B cells positively (r = –0.525, p = 0.004), age was also correlated with disease activity (r = 0.409, p = 0.031) in RA patients in this study. In healthy controls, age was not correlated with IL-10+ B cells (r = 0.035, p = 0.895). Thus, the association could be attributed to disease activity. To evaluate the effect of soluble factors in serum, IL-10+ B cell was induced with adding patients’ serum. The proportion of IL-10+ B cells was increased with serum. However, there were no differences between active RA and inactive RA group. Conclusions The proportion of induced IL-10+ B cell increased in RA patients compared to healthy control and was negatively correlated with disease activity in rheumatoid arthritis. Adding active and inactive RA patients’ sera, the proportion of IL-10+ B cell did not different between two groups. Disclosure of Interest None Declared
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