Adverse drug reactions

Patton, K.; Borshoff, D. C.

doi:10.1111/anae.14143

Cited by 67 publications

(44 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that some aspects of anaphylaxis to intravenous gelatin‐based solutions followed the typical clinical features of peri‐operative anaphylaxis . As in NAP6, the commonest presenting sign was hypotension and, consistent with peri‐operative anaphylaxis, reactions were severe.…”

Section: Discussionmentioning

confidence: 60%

Anaphylaxis to intravenous gelatin‐based solutions: a case series examining clinical features and severity

2018

View full text Add to dashboard Cite

The proportion of patients receiving intravenous gelatin-based colloids has increased in the last decade due to safety concerns about starch-based products. Recent research suggests hypersensitivity reactions to intravenous gelatin-based solutions occur at similar rates per administration as non-depolarising neuromuscular blocking agents such as rocuronium (6.2/100,000 administrations). There are scant published data on clinical features, diagnosis and time course of these reactions. We undertook a review of cases reported and tested at one of the UK's largest drug allergy clinics. All patients seen in the drug allergy clinic at Imperial College Healthcare NHS Trust (London, UK) with a confirmed diagnosis of anaphylaxis to gelatin-based solutions between May 2013 and May 2018 were included. We retrospectively reviewed clinical histories, skin test results and severity of reactions in this cohort of patients. Twelve patients with anaphylaxis to gelatin-based solutions were identified (eight women, mean (SD) age 58 (17) years). Eleven reactions were severe or lifethreatening with three progressing to cardiac arrest. Presentation was commonly delayed; only three patients suffered reactions within 5 min of the solution being administered with a further six presenting 10-70 min later. Where measured, tryptase was elevated in all patients (median (IQR [range]) 14.7 (8.2-23.8 [6.5-83.4]) ng.ml À1 ). Reactions to gelatin-based solutions are usually severe and can present with latency uncommon with other intravenous anaesthetic triggers. The use of gelatin-based solutions in the peri-operative setting should be reassessed given the risk of severe allergy.

show abstract

Section: Discussionmentioning

confidence: 60%

Anaphylaxis to intravenous gelatin‐based solutions: a case series examining clinical features and severity

2018

View full text Add to dashboard Cite

show abstract

“…ADRs cause a lot of suffering to the patient with considerable mortality and morbidity, as well as an increase in medical care expenses. Its importance becomes greater in relation to the current increase in the use of drugs, polypharmacy and multimorbidity [1,2].…”

Section: Introductionmentioning

confidence: 99%

The role of general practitioner in the study of adverse drug reactions epidemiology in ambulatory care setting

Turabián¹

2019

Arch Community Med Public Health

View full text Add to dashboard Cite

Adverse drug reactions (ADRs) cause considerable mortality and morbidity. Its importance becomes greater in relation to the current increase in the use of drugs and multimorbidity. Premarketing studies do not allow a complete knowledge of the safety of a medicine. Many ADRs occurring in the outpatient setting, but there is a signifi cant lack of information regarding the epidemiology of ADRs in this level of health care. Thus, guidance on how to direct attention to effective targets for improvement of medication safety in ambulatory care settings is missing. In this scenario, the general practitioner (GP) is in a rare, special position in the health system, which allows him to combine the clinical tasks of diagnosis and treatment on individuals with epidemiological and public health tasks on communities, including a important role in the study of ADRs's epidemiology. Among the methods aimed at identifying and quantifying the ADRs, in the GP consultation, we have: 1) Data derived from pure clinical observation; 2) Voluntary spontaneous notifi cation systems; 3) Effective local initiatives for improving the collection of reports on ADRs; 4) Careful epidemiological studies, which may include descriptive studies (crosssectional), retrospective (case-control), prospective (cohort), clinical trials, and single-case studies, seasonal variations, longitudinal studies, etc.; 5) Patient reporting of ADRs; 6) The use of algorithms for the diagnostic of ADRs; 7) Intensive telephone surveillance; 8) Collaborative work with Pharmacists working in the community; 9) From the position of the GP (where the entire medical care process begins and ends) the incidence rate of ADRs caused by hospital prescribed drugs can also be observed and collected from discharge of the hospital admissions; And 10) Genetics and electronic health records can go together to identify heritable traits to predisposition to ADRs."The scientifi c purist, who will wait for medical statistics until they are nosologically exact, is no wiser than Horace's rustic waiting for the river to flow away. " Major Greenwood, 1948.

show abstract

“…Adverse drug reactions are historically classified into two main categories, which describe a general mechanistic distinction (1,2). Type A reactions are common and their effects are predictable and mostly dose-dependent.…”

Section: Introductionmentioning

confidence: 99%

Pharmacogenetic variants associated with off-target adverse drug reactions are mostly predicted to be benign

McConnell

Field

Andrews

2019

Preprint

View full text Add to dashboard Cite

Tools that predict the functional importance of genetic variation almost always rely on sequence conservation across deep evolutionary divergences as a primary discriminator. However, sequence conservation information is misleading when predicting the functional importance of pharmacogenetic variants related to off-target adverse drug reactions. Sequence conservation is largely maintained by evolutionary purifying selection, which has not been relevant for most drugs until very recently, especially for off-target effects. Here, we use a simple classification criteria to identify variants with off-target pharmacogenetic effects from the PharmGKB database. We show that off-target pharmacogenetic variation is predicted mostly to be benign by all state-of-the-art prediction tools we tested. Hence, off-target pharmacogenetic variants are overwhelmingly invisible to all predictive methodologies currently employed. Very different analytical approaches will be needed to address this important problem. Author SummaryWhen a personal genome sequence is obtained for a given person, the sequence is compared to the human reference sequence to identify where it differs from the genome of that person. One application of this information is that it may identify how a specific person may react to particular drugs. However, when computationally predicting the functional importance of a genetic variant, the tools used rely heavily on sequence conservation information to make their prediction. From an evolutionary point of view, the use of drugs to treat diseases is a very recent activity -and one that has not had time to cause certain variants to either be selected for or removed from the population. This produces a blind-spot for tools that predict variant functional effects, especially for drugs with off-target interactions that may produce unanticipated effects.

show abstract

Adverse drug reactions

Cited by 67 publications

References 43 publications

Anaphylaxis to intravenous gelatin‐based solutions: a case series examining clinical features and severity

Anaphylaxis to intravenous gelatin‐based solutions: a case series examining clinical features and severity

The role of general practitioner in the study of adverse drug reactions epidemiology in ambulatory care setting

Pharmacogenetic variants associated with off-target adverse drug reactions are mostly predicted to be benign

Contact Info

Product

Resources

About