Anaphylaxis to Drugs

Kuruvilla, Merin; Khan, David A.

doi:10.1016/j.iac.2015.01.008

Cited by 45 publications

(40 citation statements)

References 75 publications

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“…However, anaphylaxis induced by cross hypersensitivity to NSAIDs, driven by an IgE-independent mechanism, has also been described (21–23). The most common culprits are pyrazolones, propionic acid derivatives, diclofenac, and paracetamol (10, 19, 22, 24). The incidence of NSAID-induced anaphylaxis with concomitant asthma, rhinosinusitis, and nasal polyps ranges from 2%, in children, to 97%, in adults (25).…”

Section: Drugs Causing Anaphylaxismentioning

confidence: 99%

“…Cases of vancomycin IgE-mediated anaphylaxis have been occasionally reported (38); however, this drug more commonly induces direct mast cell stimulation, associated with rapid intravenous administration, and characterized by flushing and pruritus, known as “red man syndrome” (24). In addition, this drug may lead to more severe reactions including hypotension and muscle spasms (24). …”

Section: Drugs Causing Anaphylaxismentioning

confidence: 99%

“…A positive skin test response is defined by the size of the wheal, which should be 3 mm or greater than that of the negative control (129). Testing should be performed as soon as possible to avoid loss of test sensitivity over time reported for IgE-mediated reactions to drugs (130, 131); although it should not be performed less than 6 weeks after the episode, to avoid any possible refractory period in which testing may give a false negative (24) The rate of negativization depends on the drug, ranging from 60% after 6 months for dipyrone (131) to 47% within 4 years for NBMAs (132). …”

Section: Diagnosis Of Anaphylaxis and Identification Of The Culprit Drugmentioning

confidence: 99%

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Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

et al. 2017

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Anaphylaxis is an acute, life-threatening, multisystem syndrome resulting from the sudden release of mediators by mast cells and basophils. Although anaphylaxis is often under-communicated and thus underestimated, its incidence appears to have risen over recent decades. Drugs are among the most common triggers in adults, being analgesics and antibiotics the most common causal agents. Anaphylaxis can be caused by immunologic or non-immunologic mechanisms. Immunologic anaphylaxis can be mediated by IgE-dependent or -independent pathways. The former involves activation of Th2 cells and the cross-linking of two or more specific IgE (sIgE) antibodies on the surface of mast cells or basophils. The IgE-independent mechanism can be mediated by IgG, involving the release of platelet-activating factor, and/or complement activation. Non-immunological anaphylaxis can occur through the direct stimulation of mast cell degranulation by some drugs, inducing histamine release and leading to anaphylactic symptoms. Work-up of a suspected drug-induced anaphylaxis should include clinical history; however, this can be unreliable, and skin tests should also be used if available and validated. Drug provocation testing is not recommended due to the risk of inducing a harmful reaction. In vitro testing can help to confirm anaphylaxis by analyzing the release of mediators such as tryptase or histamine by mast cells. When immunologic mechanisms are suspected, serum-sIgE quantification or the use of the basophil activation test can help confirm the culprit drug. In this review, we will discuss multiple aspects of drug-induced anaphylaxis, including epidemiology, mechanisms, and diagnosis.

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Section: Drugs Causing Anaphylaxismentioning

confidence: 99%

Section: Drugs Causing Anaphylaxismentioning

confidence: 99%

Section: Diagnosis Of Anaphylaxis and Identification Of The Culprit Drugmentioning

confidence: 99%

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Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

et al. 2017

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“…54 Moreover, this diagnostic tool can be used to find alterna tives to the culprit drug and to assess tolerance to potentially crossreactive drugs. 55 Immunoassays IgEmediated allergy to βlactams is diagnosed with antibodybased immunoassays that use several solid phases (agarose, cellulose discs), carrier molecules (human serum albumin, polylisine), and different determinants (BP, AX, and cephalosporins). Today, the ImmunoCAP system (ThermoFisher, Uppsala, Sweden), which works by a high surfacecapacity solidphase as say using a secondary fluorolabeled antibody, re mains the most widely used commercial method for diagnosing βlactam allergy.…”

Section: Immediate or Immunoglobulin-e-mediated Reac-mentioning

confidence: 99%

“…At pres ent, BPO is maintained as the major determinant, in this case conjugated to octalpolylysine, and a single minor determinant, benzylpenilloate, not present in the remaining smaller determinants described due to their high instability. 39 In ad dition, Romano et al 40 reported a small percent age of βlactam allergic patients (<5%) who test ed negative for BPOPPL and MDM, but positive for BP, recommending the inclusion of BP in the battery of skin tests.At present, due to the changing patterns of βlactam use, and the appearance of sidechain specific reactions, it is necessary to use other determinants, such as AX or some 55 Immunoassays IgEmediated allergy to βlactams is diagnosed with antibodybased immunoassays that use several solid phases (agarose, cellulose discs), carrier molecules (human serum albumin, polylisine), and different determinants (BP, AX, and cephalosporins). Today, the ImmunoCAP system (ThermoFisher, Uppsala, Sweden), which works by a high surfacecapacity solidphase as say using a secondary fluorolabeled antibody, re mains the most widely used commercial method for diagnosing βlactam allergy.…”

mentioning

confidence: 99%

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Moreno¹,

Laffond²,

Muñoz-Bellido³

et al. 2017

Polish Archives of Internal Medicine

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ABSTRACTβ-lactams are the most widely used antibiotic family, but they are also the most common cause of drug-induced hypersensitivity reactions. The estimated prevalence of reported penicillin allergy ranges between 9% and 12%, although a high percentage of patients with a history of penicillin allergy have no subsequent reactions on reexposure to β-lactams. A self-reported penicillin allergy has been associated with antimicrobial resistance, increased cost, intensive care admission, and death, making it essential to establish an accurate diagnosis. In addition to a thorough clinical history, diagnostic methods include skin tests, in vitro tests, and drug-challenge tests. In this review, the diagnosis and management of patients with self-reported penicillin allergy is discussed, including the recently introduced antimicrobial stewardship strategy.REVIEW ARTICLE Use of β-lactam antibiotics in patients with a history of β-lactam allergy 541Antigenic determinants of β-lactams Penicillins and βlactams are generally considered immuno logically haptens and need to bind to carrier mol ecules to acquire complete immunogenic poten cy. The binding of the antibiotic to amino groups of autologous proteins induces a conformational modification that causes the immune system to recognize them as strange. The βlactam rings and the side group are all potentially immunogenic.Penicillins have been the most studied antibiot ics. The βlactam ring is intrinsically reactive and does not need prior metabolism. The instability of its structure makes it open quickly, allowing the carbonyl groups to form amidetype linkages with the amino groups of the lysine residues of the nearby proteins. 26 As approximately 95% of the penicillin molecules are bound to proteins in this manner, the antigenic determinant formed, benzylpenicilloyl (BPO), has been known as the major antigenic determinant of penicillin. BPO has been attached to a weakly immunogenic car rier molecule, called polylysine, to form benzyl penicilloyl polylysine (BPOPPL), which is used in making skin tests. The remaining part of the penicillin molecule degrades to a range of deriv atives which can also act as haptens. 27 These are minor determinants accounting for allergic reac tions in approximately 10% to 20% of patients. 23 The minor determinant mixture (MDM) has been also used in skin tests.The progressive increase in the consumption of amoxicillin (AX) has led to an increase in the detection of patients allergic to AX who tolerate benzylpenicillin (BP).28 These reactions are called selective reactions to AX. The major antigenic de terminant of AX is the amoxicilloyl amide, which results from the opening of the βlactam ring by amino groups. 29 Although the structure of the possible antigen ic elements of cephalosporins is not well known, different experimental studies have proved that they can generate structures able to provoke spe cific immune response. 30 IgE antibodies that re act with cephalosporins have been shown to de tect a wide range of specificities, although the f...

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Medication contaminants as a potential cause of anaphylaxis to vincristine

Hill

Leahy

Sciasci

et al. 2017

Pediatric Blood & Cancer

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Vincristine (VCR) is a vinca alkaloid and common chemotherapeutic that is used to treat multiple pediatric and adult malignancies. Despite its common use, cases of anaphylaxis to VCR are rare and typically isolated to a single individual. We report a series of eight patients with adverse reactions to VCR over the course of 11 months at a single institution, four of which progressed to anaphylaxis and one of which resulted in cardiac arrest. Mass spectrometry analysis of medication lots was concerning for possible contaminant. Our findings highlight the risk of anaphylaxis during therapy with VCR.

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Anaphylaxis to Drugs

Cited by 45 publications

References 75 publications

Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

Epidemiology, Mechanisms, and Diagnosis of Drug-Induced Anaphylaxis

Using beta-lactam antibiotics in patients with a history of beta-lactam allergy: current concepts

Medication contaminants as a potential cause of anaphylaxis to vincristine

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