Epidemiology of hypersensitivity drug reactions

Gomes, Eva; Démoly, P.

doi:10.1097/01.all.0000173785.81024.33

Cited by 364 publications

(211 citation statements)

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“…Factors such as concurrent drug intake, infection, exercise and physical activity and underlying food allergy may synergistically interact with each other and precipitate a hypersensitivity reaction or increase its severity. 2 From our results, DPTs seem a safe procedure in the paediatric population. Despite the lowest rate of DPTs in skin tested children to betalactams, the number of positive DPTs in the non-skin tested children was extremely low and demonstrates that the majority of the suspected allergic ADR are non-reproducible in a subsequent exposure.…”

Section: Discussionmentioning

confidence: 59%

“…Less than 10% of patients treated with betalactam antibiotics report an adverse drug reaction suggestive of having an immunological mechanism. 1,2 In children, the prevalence of allergic adverse reactions to betalactam seems to be significantly lower than in adults, as in paediatric age infectious diseases are responsible for the clinical picture. 3,4 In clinical practice, patients who have experienced a drug reaction are frequently categorised as being allergic to the culprit drug without any further investigation.…”

Section: Introductionmentioning

confidence: 99%

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Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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Background: Few studies have been performed in children with suspected betalactam allergy. We aimed to assess the role of the drug provocation test (DPT) with betalactams in a paediatric setting and to study the association between allergy to betalactam antibiotics and other allergic diseases. Methods: We included all the patients under 15 years old who were consecutively referred to the Immunoallergy Department, Dona Estefânia Hospital, Portugal (January 2002 to April 2008) for a compatible history of allergic reaction to betalactam. All were submitted to a DPT. Children were proposed to perform skin tests (ST) to betalactam antibiotics followed by DPT. If they decline ST, a DPT with the culprit drug was performed. Results: We studied 161 children, 60% were boys, with a median age of 5 years old at the time of the DPT. Thirty-three patients (20.5%) had an immediate reaction and 33 (20.5%) a non-immediate reaction. The severity of the reported reactions was low in most cases. Skin tests to betalactams were performed in 47 children and were positive in 8. DPT was positive in only one (3.4%) of the patients skin tested and in 11 (13.4%) of those not skin tested. The severity of the DPT reaction was low. Asthma and food allergy were associated with a positive DPT in the later group. Conclusions: DPT seems a safe procedure even in the absence of ST in non-severe cases. This could be a practical option in infants and pre-school children, where ST are painful and difficult to perform. Additional caution should be taken in children with asthma and food allergy.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Chambel

Martins

Silva

et al. 2010

Allergologia et Immunopathologia

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“…Current attempts to identify patients who are likely to develop hypersensitivity have met with limited success [23,33]. General factors that increase the likelihood of experiencing a type 1 hypersensitivity reaction have been identi- [5].…”

Section: Management Of Hypersensitivity and Infusion Reactionsmentioning

confidence: 99%

Management and Preparedness for Infusion and Hypersensitivity Reactions

2007

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LEARNING OBJECTIVESAfter completing this course, the reader will be able to:1. Discuss the physiology of the different clinical hypersensitivity and infusion reactions to monoclonal antibodies and chemotherapy.2. Select appropriate prevention and treatment strategies for hypersensitivity reactions.3. Describe the differences between acquired and acute hypersensitivity reactions.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTBackground. Like nearly all systemic cancer therapies, monoclonal antibodies are associated with hypersensitivity reactions. This article reviews the characteristics and management of hypersensitivity reactions to monoclonal antibodies and commonly used chemotherapy agents. Methods. MEDLINE was searched for recent studies and reviews pertaining to hypersensitivity reactions with monoclonal antibodies (cetuximab, rituximab, trastuzumab, panitumumab, bevacizumab), platinum compounds (carboplatin, oxaliplatin), and taxanes (paclitaxel, docetaxel). Emphasis was placed on articles that provided practical information on hypersensitivity reaction management. Data found in the literature were supplemented with information from the package insert for each agent.Results. Severe hypersensitivity reactions are rare, with an incidence of <5%, provided patients receive proper premedication, close monitoring, and prompt intervention when symptoms occur. Hypersensitivity reactions to platinum compounds are generally consistent with type 1 hypersensitivity, occurring after multiple cycles of therapy. Reactions to taxanes and mono-

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“…HLA polymorphisms, metabolic enzymes), concurrent infection (e.g. herpes virus), and overall immune status (Gomes & Demoly, 2005;Ozcan et al, 2010). There has been a significant amount of interest in HLA variants, particularly since genome-wide association studies have revealed associations between specific HLA alleles and drug hypersensitivity responses, e.g.…”

Section: Introductionmentioning

confidence: 99%

Development and partial validation of a mouse model for predicting drug hypersensitivity reactions

Whritenour

Cole

Zhu

et al. 2013

Journal of Immunotoxicology

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Animal models that can be used to predict the allergenic potential of drug candidates have not been adequately optimized, validated, or characterized. While initial validation data from an inter-laboratory study of the mouse lymph node proliferation assay (LNPA) appeared promising, no additional investigations in this model have been reported. The objectives of this study were to use positive and negative control drugs to further optimize and validate the LNPA utilizing a non-radioactive endpoint and determine the sensitivity, specificity, and predictivity of the model. Drugs associated with hypersensitivity reactions in the literature were chosen to test in the model in addition to drugs with few or no reports of hypersensitivity. Mice received a subcutaneous injection of drug or vehicle into the scruff of the neck once daily for a period of 3 days. On Day 6, draining lymph nodes were harvested, single cell suspensions prepared, and total cell numbers determined for each animal by flow cytometry. A stimulation index was calculated by dividing the mean total cell number for the drug-treated group by the mean total cell number for the vehicle-treated animals. Based on statistical analysis of the data, animals with a total cell number !2.5Â the mean of the vehicle group were classified as 'responders'. Based on data generated to date with 12 positive control and six negative control drugs, the model had a sensitivity of 75%, a specificity of 74%, and a relatively good predictive value (measured by the Receiver Operating Characteristic AUC of 0.80). The data here suggest that this model may be a useful tool for identifying drug candidates with the potential to produce allergic responses in the clinic. Future studies will investigate the mechanism(s) for the lymph node responses in order to develop additional endpoints that may increase the sensitivity and specificity of the model.

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Epidemiology of hypersensitivity drug reactions

Cited by 364 publications

References 71 publications

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Drug provocation tests to betalactam antibiotics: experience in a paediatric setting

Management and Preparedness for Infusion and Hypersensitivity Reactions

Development and partial validation of a mouse model for predicting drug hypersensitivity reactions

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