T cell–mediated reactions to iodinated contrast media: Evaluation by skin and lymphocyte activation tests

Kanny, G.; Pichler, Werner J.; Morisset, M.; Franck, P.; Marie, Béatrice; Kohler, Chantal; Renaudin, Jean‐Marie; Beaudouin, É.; Laudy, J. Sainte; Moneret-Vautrin, D. A.

doi:10.1016/j.jaci.2004.09.012

Cited by 123 publications

(105 citation statements)

References 38 publications

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“…[1] Allergic reaction to H1 blockers noted in some of our patients was also reported earlier. [4,8] The antibiotic sensitivity noted in 50% of our cases was in concordance with previous studies. [4,8,10] Two more episodes of drug reactions within six months of resolution of DRESS noted in one of our patients was consistent with the earlier reports citing severe drug reaction as a predisposing factor for multiple drug allergy.…”

Section: Discussionsupporting

confidence: 92%

“…[4,8] The antibiotic sensitivity noted in 50% of our cases was in concordance with previous studies. [4,8,10] Two more episodes of drug reactions within six months of resolution of DRESS noted in one of our patients was consistent with the earlier reports citing severe drug reaction as a predisposing factor for multiple drug allergy. Pichler et al proposed immune activation induced by severe drug reaction to be an inciting factor for neo-sensitisation to other drugs.…”

Section: Discussionsupporting

confidence: 92%

“…[1] The mean age of our study population was slightly lower than that observed in previous studies (51-62 yrs). [4,8] Similar to our observations, others also noted multiple drug allergy to be rare in children; but Atanaskovic et al in their study on drug reaction in pediatric population documented that 2.5% of those with suspected drug allergy were allegic to multiple drugs. [9] The reaction patterns observed were comparable to existing data on multiple drug allergy.…”

Section: Discussionsupporting

confidence: 88%

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A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

Sukumarakurup¹,

Riyaz²,

Sasidharanpillai³

et al. 2015

jemds

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BACKGROUNDThough multiple drug allergy syndrome or multiple drug hypersensitivity syndrome has been described as a distinct entity, not much data is available on the same, especially in Indian literature. AIMSTo study the incidence of multiple drug allergy syndrome among patients with cutaneous adverse drug reaction (CADR) attending a referral centre and to study its clinical and epidemiological features and evidence of autoimmunity. METHODSAll patients admitted in Dermatology ward of our tertiary care hospital for a 2-year period from 1 st August 2012 to 31 st July 2014 with CADR were studied for documented evidence of CADR to two or more unrelated drugs. The subjects were included in this prospective study after clearance from institutional ethics committee and written informed consent from study subjects. The cases identified as multiple drug allergy syndrome were studied in a more detailed manner and were evaluated for comorbidities with special reference to autoimmune diseases and human immunodeficiency virus infection. The clinical patterns and the common offending drugs were studied. RESULTSDuring the two-year study period, 10 out of the 94 patients with CADR included in the study were found to be belonging to the category of multiple drug allergy syndrome (After strict scrutiny) with a clear female predilection (70%). The different reaction patterns in patients with multiple drug allergy syndrome were fixed drug eruption, urticaria, erythema multiforme, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS) and exfoliative dermatitis. Six out of ten patients with multiple drug allergy syndrome showed positivity on antinuclear antibody profile and two were diagnosed to have systemic lupus erythematosus. CONCLUSIONSA 10.6% of those admitted with CADR have multiple drug allergy syndrome, which exists as a separate entity. Female predominance and the evidence of autoimmune manifestations in the majority underscores the need to evaluate the role of autoimmunity in precipitating allergy to multiple drugs. Large prospective studies with age and sex matched controls in different population groups may throw light on the less known aspects of this syndrome. A decision to investigate all patients with allergy to multiple drugs for evidence of autoimmunity may be worthwhile.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 88%

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A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

Sukumarakurup¹,

Riyaz²,

Sasidharanpillai³

et al. 2015

jemds

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“…The allergen is likely related to the molecule (fig. 5) as it has also been recently supported by lymphocyte transformation tests and T cell lines [14]. Despite the positive patch test to povidone iodine, which does release iodine, our results indicate that iodine itself is not involved as it has also been proposed by other authors [8].…”

Section: Discussionsupporting

confidence: 73%

Recurrent Flexural Exanthema (SDRIFE or Baboon Syndrome) after Administration of Two Different Iodinated Radio Contrast Media

et al. 2006

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In 1984, the baboon syndrome was described as a particular form of systemic contact dermatitis that occurred after the administration of a contact allergen in individuals previously sensitized by topical exposure to the same allergen. Its clinical picture presents as an erythema of the buttocks and upper inner thighs resembling the red bottom of baboons. This specific reaction was originally observed with mercury, nickel and ampicillin. Since then over 100 cases have been described, most of them without known prior sensitization to the causative agent. In 2004, our group proposed the acronym SDRIFE specifically for cases associated with systemic drugs; it stands for symmetrical drug-related intertriginous and flexural exanthema, as a distinct reaction pattern related to systemic drugs. Here we describe a case of SDRIFE after administration of the iodinated radio contrast medium (RCM) iomeprol (Iomeron®), accidentally reproduced by the RCM iopromide (Ultravist®). Positive delayed skin tests with both drugs were observed indicating that the pathomechanism of SDRIFE is likely a cell-mediated type IV allergy. Oral potassium iodide and a skin-test-negative RCM were administered and both tolerated, indicating that the antigen is related to the molecules and not to iodine itself. Therefore, in our case skin tests had a good positive and negative predictive value.

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“…Several research groups have tried to improve LTT sensitivity by various modifications such as measuring cytokines in the lymphocyte supernatants, analyzing lymphocyte activation markers such as CD69 by flow cytometry or coculturing lymphocytes with cytokines such as alpha interferon [27][28][29][30]. We could not analyze these alternative methods systematically in parallel to the LTT.…”

Section: Discussionmentioning

confidence: 99%

Evidence for immunological (allergic) mechanisms in a subgroup of patients with phenprocoumon-induced liver disease

Klein

2009

Eur J Clin Pharmacol

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To cite this version:Reinhild Klein. Evidence for immunological (allergic) mechanisms in a subgroup of patients with phenprocoumon-induced liver disease. Abstract Purpose Phenprocoumon-induced liver injury is a rare complication of oral anticoagulation. The mechanisms leading to this side effect are not entirely clear. Here we present data that at least in a subgroup of patients in whom phenprocoumon-induced liver disease was suspected, immunological processes may play an important role. Patients and methods Thirty patients with suspected phenprocoumon-induced liver disease from different hospitals in Germany were analyzed. Peripheral blood mononuclear cells (PBMC) of these patients were tested in the lymphocyte transformation test (LTT) for reactivity with phenprocoumon in vitro. As controls, PBMC were isolated from ten individuals treated with phenprocoumon but without any side effects, and from ten healthy individuals who have never received the drug. Results Fifteen of the 30 patients had sensitized lymphocytes toward phenprocoumon as shown by LTT. Four patients had taken the drug for more than 5 years; in one patient, liver disease appeared after 1 day of phenprocoumon intake. There was no correlation between a positive LTT and clinical/ laboratory parameters. None of the 20 controls had sensitized lymphocytes toward phenprocoumon. Conclusions Applying the LTT, we were able to unravel the cause of suspected phenprocoumon-induced liver injury as a drug allergic reaction in 15 out of 30 analyzed patients.

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T cell–mediated reactions to iodinated contrast media: Evaluation by skin and lymphocyte activation tests

Cited by 123 publications

References 38 publications

A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

A Study on the Clinico - Epidemiological Aspects and Evidence of Autoimmunity in Patients With Multiple Drug Allergy Syndrome

Recurrent Flexural Exanthema (SDRIFE or Baboon Syndrome) after Administration of Two Different Iodinated Radio Contrast Media

Evidence for immunological (allergic) mechanisms in a subgroup of patients with phenprocoumon-induced liver disease

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