Desensitization to antibiotics in children

Abstract

Drug hypersensitivity reactions can occur to almost all drugs and antibiotics are among the most common cause for this kind of reactions. Drug hypersensitivity may affect any organ or system, and manifestations range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. In case of infection, there is usually a safe antibiotic alternative. Nonetheless, in some cases, no alternative treatment exists for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance to a drug which can only be maintained by continuous administration of the medication responsible for the hypersensitivity reaction. Desensitization is mainly performed in IgE-mediated reactions. Increasing doses of the implicated drug are administered over a short period of time, until the therapeutic dose is achieved and tolerated. Very few studies confined to children are found in literature. Most of them are case reports. In general, the proposed desensitization schemes are similar to those used in adults differing only in the final dose administered. The purpose of this study is to review desensitization to antibiotics in children presenting and discussing three clinical practical cases of desensitization in this age group.

Head-to-Head Comparison of Protocol Modifications for the Generation of Collagen-Induced Arthritis in a Specific-Pathogen Free Facility Using DBA/1 Mice

“…One possible explanation for this result may be that non-joint-associated injected CII may act as a scavenger for available CII-specific antibodies, thus preventing their binding with joint-associated CII and preventing concomitant local T-cell activation, joint inflammation, and pathology. This scavenger explanation could be likened to part of the theoretic basis of rush desensitization used in rapid allergy treatment where a cumulative large dose of Ag given in multiple doses over a relatively short period of time quickly occupies most available Ag-specific antibody binding sites, thus allowing for further Ag exposure without induction of life-threatening allergic symptoms (34, 35). Regardless, CII when given with LPS appears to guide the non-specific inflammatory response raised by LPS in a directed fashion toward CII-specific T-cell release of additional IFN- and B-cell secretion of additional CII-specific IgG1, IgG2a, and IgG2b (Figure 4) and more severe pathology (Figure 3, D and E).…”

Hipersensibilidade aos β-lactâmicos e outros antibióticos. Bases biológicas

“…De uma forma geral, a melhor abordagem para evitar reações de hipersensibilidade em pacientes com esse histórico é evitar a prescrição de medicamentos que pertençam ao mesmo grupo do fármaco que produziu a reação notificada 32 , o que nem sempre é possível, como ocorre em pacientes HIV positivos com hipersensibilidade às sulfas e que necessitam dessa classe de drogas (amprenavir e fosamprenavir) como inibidores de protease 32 . Nessas situações, podese optar pela terapia de dessensibilização, que apresenta diversas limitações em termos de efetividade e segurança 33 . Aspecto relevante observado entre os dados coletados foi a ausência de relatos de alergias aos macrolídeos e lincosaminas, drogas amplamente utilizadas na clínica médico-odontológica como opção viável aos pacientes com histórico de hipersensibilidade aos β-lactâmicos.…”

“…É importante enfatizar que essa modalidade de dessensibilização perdura por um período de 24-36 horas, nas quais os mastócitos não mais degranulam em função da supressão induzida, mas o paciente permanece com as bases imunológicas de sua hipersensibilidade ao antimicrobiano e poderá ter uma reação intensa à droga fora desse período de segurança 10 . Como as terapias de dessensibilização podem, elas próprias dar origem a quadros de hipersensibilidade graves, as mesmas não são indicadas para pacientes com histórico de síndrome de Stevens-Johnson, necrólise epidermal tóxica, quadros de vasculites, citopenias e reações sistêmicas 33 .…”

Skin testing, graded challenge, and desensitization to von Willebrand factor (VWF) products in type III von Willebrand disease (VWD)

“…This is consistent with previous reports of utilization of such procedure in some other cases of non IgE-mediated drug reactions. 8,9 To our knowledge this is the first report of skin testing, graded challenge and desensitization protocols to VWF products. These procedures and protocols may be of benefit in other patients with reactions to VWF products.…”