Drug-induced anaphylaxis: Seven-year single-center survey

Mota, Inês; Gáspár, Angéla; Benito-Garcia, Filipe; Alves‐Correia, Magna; Chambel, Marta; Morais‐Almeida, Mário

doi:10.23822/eurannaci.1764-1489.66

Cited by 22 publications

(18 citation statements)

References 17 publications

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“…In the case of anaphylaxis, the most frequent elicitors are nonsteroidal antiinflammatory drugs (NSAIDs), antibiotics (both betalactams [BLs] and non-BLs), radiocontrast media and anaesthetic agents. [6][7][8][9] Regarding SCARs, the drugs involved depend on the population (adults or children). In this sense, antibiotics and anticonvulsants are the most common ones in adults 10 ; and antibiotics, NSAIDs, and chemotherapeutics 11 as well as aromatic anticonvulsants and also allopurinol are the most frequently involved in children.…”

Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management.Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication.Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de-labelling of patients previously false-reported as allergic, which will improve the management and treatment of patients with DHRs. K E Y W O R D Sallergy diagnosis, allergy treatment, basic mechanisms, drug allergy, epidemiology | 2369

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Section: The Burden Of Drug Hyper S En S Itivit Ymentioning

confidence: 99%

Recent developments and highlights in drug hypersensitivity

Mayorga

Fernandez

Montañez

et al. 2019

Allergy

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“…NSAIDs are the main elicitors of drug hypersensitivity reactions (DHRs) . NSAIDs hypersensitivity among general population is frequent (0.5%‐5.7%), overcoming antibiotics allergy in some studies . However, in high‐risk populations it increases: up to 20% in asthmatics with nasal polyps (NPs) and to 30% in chronic spontaneous urticaria (CSU) patients …”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] NSAIDs hypersensitivity among general population is frequent (0.5%-5.7%), overcoming antibiotics allergy in some studies. 5,8,9 However, in high-risk populations it increases: up to 20% in asthmatics with nasal polyps (NPs) and to 30% in chronic spontaneous urticaria (CSU) patients. 10 The European Academy of Allergy, Asthma and Clinical Immunology (EAACI) distinguishes cross-reactive and selective hypersensitivity reactions (CRs and SHRs, respectively; Figures 1 and 2).…”

Section: Introductionmentioning

confidence: 99%

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Doña

Pérez‐Sánchez

Eguiluz‐Gracia

et al. 2019

Allergy

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Nonsteroidal anti‐inflammatory drugs (NSAIDs), the medications most commonly used for treating pain and inflammation, are the main triggers of drug hypersensitivity reactions. The latest classification of NSAIDs hypersensitivity by the European Academy of Allergy and Clinical Immunology (EAACI) differentiates between cross‐hypersensitivity reactions (CRs), associated with COX‐1 inhibition, and selective reactions, associated with immunological mechanisms. Three phenotypes fill into the first group: NSAIDs‐exacerbated respiratory disease, NSAIDs‐exacerbated cutaneous disease and NSAIDs‐induced urticaria/angioedema. Two phenotypes fill into the second one: single‐NSAID‐induced urticaria/angioedema/anaphylaxis and single‐NSAID‐induced delayed reactions. Diagnosis of NSAIDs hypersensitivity is hampered by different factors, including the lack of validated in vitro biomarkers and the uselessness of skin tests. The advances achieved over recent years recommend a re‐evaluation of the EAACI classification, as it does not consider other phenotypes such as blended reactions (coexistence of cutaneous and respiratory symptoms) or food‐dependent NSAID‐induced anaphylaxis. In addition, it does not regard the natural evolution of phenotypes and their potential interconversion, the development of tolerance over time or the role of atopy. Here, we address these topics. A state of the art on the underlying mechanisms and on the approaches for biomarkers discovery is also provided, including genetic studies and available information on transcriptomics and metabolomics.

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“…In a case series from our centre, cefazolin represented 16% of beta-lactam-induced anaphylaxis (7 in 43 patients) [18]. We speculate this higher incidence might be due to the frequent use of this first-generation cephalosporin, by parenteral route, in prophylactic surgical protocols.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

Mota

Gáspár

Morais‐Almeida³

2018

Int Arch Allergy Immunol

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Background: Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions. Methods: Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests. Results: We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE-mediated hypersensitivity through positive skin tests to cefazoline has been proven in all patients. Two patients experienced systemic reactions during skin testing. All patients were successfully challenged with amoxicillin, and they tolerated cefuroxime. Conclusions: Cefazolin can be responsible for immediate severe allergic reactions in perioperative setting, including KS. Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. Our experience confirmed that patients with IgE-mediated hypersensitivity reactions to cefazolin can tolerate other beta-lactams. This selective pattern of clinical reactivity may be explained by its particular chemical structure, whose R1 side-chain is different from other beta-lactams.

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Drug-induced anaphylaxis: Seven-year single-center survey

Cited by 22 publications

References 17 publications

Recent developments and highlights in drug hypersensitivity

Recent developments and highlights in drug hypersensitivity

Progress in understanding hypersensitivity reactions to nonsteroidal anti‐inflammatory drugs

Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy

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