Delayed Hypersensitivity to Diclofenac: a Report on Two Cases

Romano, Antonino; Quaratino, Donato; Papa, G; Fonso, M. Di; Artesani, Maria Cristina; Venuti, A

doi:10.1016/s1081-1206(10)63131-6

Cited by 9 publications

(4 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They speculate that underlying molecular differences exist in these patients that make the skin more susceptible to COX-2 inhibitors. Although rare, both photocontact and allergic contact dermatitis has been reported 29. In two patients who developed maculopapular eruptions 48 and 72 hours after initiation of treatment with diclofenac + hyaluronic acid, prick and intra-dermal tests were negative at 20 minutes, but 24 hours later an erythematous infiltrate had appeared at the intradermal test site 30.…”

Section: Available Topical Therapiesmentioning

confidence: 98%

Diclofenac gel in the treatment of actinic keratoses

Nelson¹

2011

TCRM

View full text Add to dashboard Cite

show abstract

Section: Available Topical Therapiesmentioning

confidence: 98%

Diclofenac gel in the treatment of actinic keratoses

Nelson¹

2011

TCRM

View full text Add to dashboard Cite

show abstract

“…The most frequent reports of positive drug patch tests are related to the following drugs: betalactam antibiotics, especially amoxicillin (1,2,4,6,18,(24)(25)(26)(27)(28)(29)(30), cotrimoxazole (15), corticosteroids (1,31,32), heparin derivatives (1,(33)(34)(35)(36), pristinamycin (1,36), carbamazepine (1,2,20,(37)(38)(39)(40)(41)(42)(43)(44), diltiazem (1,45,46), diazepam (47), hydroxyzine (1,48), pseudoephedrine (1,21,22) and tetrazepam (1,16,(49)(50)(51).…”

Section: Commentmentioning

confidence: 99%

“…Prick tests and IDT have also been performed with other drugs such as diltiazem (45), heparin derivatives (33)(34)(35), insulin (45), oestradiol (1) and corticosteroids (56).…”

Section: Prick Tests and Idtmentioning

confidence: 99%

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

et al. 2001

View full text Add to dashboard Cite

Skin testing with a suspected drug has been reported to be helpful in determining the cause of cutaneous adverse drug reactions (CADR). Many isolated reports of positive drug skin tests are published, but without detailed information concerning the clinical features of the CADR and the method used in performing drug skin tests, such data are not very informative. A working party of the European Society of Contact Dermatitis (ESCD) for the study of skin testing in investigating cutaneous adverse drug reactions, has proposed the herein-reported guidelines for performing skin testing in CADR in order to standardize these procedures. In each reported case, the imputability of each drug taken at the onset of the CADR and a highly detailed description and characterization of the dermatitis need to be given. Drug skin tests are performed 6 weeks to 6 months after complete healing of the CADR. Drug patch tests are performed according to the methods used in patch testing in studying contact dermatitis. The commercialized form of the drug used by the patient is tested diluted at 30% pet. (pet.) and/or water (aq.). The pure drug is tested diluted at 10% in pet. or aq. In severe CADR, drug patch tests are performed at lower concentrations. It is also of value to test on the most affected site of the initial CADR. Drug prick tests are performed on the volar forearm skin with the commercialized form of the drug, but with sequential dilutions in cases of urticaria. Intradermal tests (IDT) are performed with sterile sequential dilutions (10-4, 10-3, 10-2, 10-1) of a pure sterile or an injectable form of the suspected drug with a small volume of 0.04 ml. Drug skin tests need to be read at 20 min and also later at D2 and D4 for patch tests, at D1 for prick tests and IDT. All these tests also need to be read at 1 week. The success of skin tests varies with the drug tested, with a high % of positive results, for example, with betalactam antibiotics, pristinamycin, carbamazepine and tetrazepam on patch testing, or with betalactam antibiotics and heparins on delayed readings of IDT. The results of drug skin tests also depend on the clinical features of the CADR. The use of appropriate control patients is necessary to avoid false-positive results.

show abstract

“…There have been case reports of diclofenac-induced immune hemolysis [ 87 ] and delayed hypersensitivity reactions [ 88 ]. One study investigated antibody responses to diclofenac and some of its metabolites in a cohort of 59 patients who experienced hypersensitivity reactions [ 89 ].…”

Section: Discussionmentioning

confidence: 99%

Diclofenac Disrupts the Circadian Clock and through Complex Cross-Talks Aggravates Immune-Mediated Liver Injury—A Repeated Dose Study in Minipigs for 28 Days

Selvaraj

Yoon

et al. 2023

IJMS

View full text Add to dashboard Cite

Diclofenac effectively reduces pain and inflammation; however, its use is associated with hepato- and nephrotoxicity. To delineate mechanisms of injury, we investigated a clinically relevant (3 mg/kg) and high-dose (15 mg/kg) in minipigs for 4 weeks. Initially, serum biochemistries and blood-smears indicated an inflammatory response but returned to normal after 4 weeks of treatment. Notwithstanding, histopathology revealed drug-induced hepatitis, marked glycogen depletion, necrosis and steatosis. Strikingly, the genomic study revealed diclofenac to desynchronize the liver clock with manifest inductions of its components CLOCK, NPAS2 and BMAL1. The > 4-fold induced CRY1 expression underscored an activated core-loop, and the dose dependent > 60% reduction in PER2mRNA repressed the negative feedback loop; however, it exacerbated hepatotoxicity. Bioinformatics enabled the construction of gene-regulatory networks, and we linked the disruption of the liver-clock to impaired glycogenesis, lipid metabolism and the control of immune responses, as shown by the 3-, 6- and 8-fold induced expression of pro-inflammatory CXCL2, lysozyme and ß-defensin. Additionally, diclofenac treatment caused adrenocortical hypertrophy and thymic atrophy, and we evidenced induced glucocorticoid receptor (GR) activity by immunohistochemistry. Given that REV-ERB connects the circadian clock with hepatic GR, its > 80% repression alleviated immune responses as manifested by repressed expressions of CXCL9(90%), CCL8(60%) and RSAD2(70%). Together, we propose a circuitry, whereby diclofenac desynchronizes the liver clock in the control of the hepatic metabolism and immune response.

show abstract

Delayed Hypersensitivity to Diclofenac: a Report on Two Cases

Cited by 9 publications

References 16 publications

Diclofenac gel in the treatment of actinic keratoses

Diclofenac gel in the treatment of actinic keratoses

Guidelines for performing skin tests withdrugs in the investigation of cutaneous adverse drug reactions

Diclofenac Disrupts the Circadian Clock and through Complex Cross-Talks Aggravates Immune-Mediated Liver Injury—A Repeated Dose Study in Minipigs for 28 Days

Contact Info

Product

Resources

About