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INTRODUCTION: For inflammation of a tattoo occurring decades after its creation, sarcoidosis should be considered first of all. Two case of extremely delayed hypersensitivity tattoo reaction have been recently reported in patients treated with BRAF and MEK inhibitors. We report a similar new case strongly suggesting a specific effect of this drug combination. PATIENTS AND METHODS: A 58-year-old man bearing 20-year-old tattoos was treated with dabrafenib and trametinib for advanced melanoma. A painful erythematous swelling appeared on all the patient's tattoos two months later, while his general tolerance of the treatment was poor. Skin biopsy demonstrated perivascular lympho-histiocytic infiltrate without granuloma, but with prominent pigment-loaded macrophages. Inflammatory signs quickly regressed after drug discontinuation. DISCUSSION: Great similarity exists between this new case and the first reported case, in which a female patient presented painful infiltration of old tattoos following repeated reintroduction of dabrafenib and trametinib in a setting of advanced melanoma. The immunomodulatory properties BRAF/MEK inhibition may enhance loss of tolerance to tattoo ink, accounting for the extremely long time to reaction. This third case militates in favour of a specific drug-induced reaction, of which patients with tattoos should be informed when anti-BRAF/MEK therapy is being considered.
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Eritema/etiología , Hipersensibilidad/etiología , Inhibidores de Proteínas Quinasas/efectos adversos , Tatuaje/efectos adversos , Humanos , Imidazoles/efectos adversos , Masculino , Melanoma/tratamiento farmacológico , Persona de Mediana Edad , Oximas/efectos adversos , Piridonas/efectos adversos , Pirimidinonas/efectos adversos , Neoplasias Cutáneas/tratamiento farmacológicoRESUMEN
Low molecular weight heparins (LMWHs) are used for a variety of indications. The most common type of hypersensitivity reactions to LMWHs are delayed-type hypersensitivity reactions (DHR). Immediate-type hypersensitivity reactions (IHR) occur only sporadically. Cross-reactivity of different LMWHs is a common and unpredictable problem. We present 2 cases of patients who developed DHR to nadroparin and enoxaparin, respectively. The third case presents a patient who developed IHR to nadroparin. Skin tests confirmed the hypersensitivity in all cases. In the cases of DHR, a skin test negative LMWH was identified and was tolerated in a challenge test. In the IHR case, cross-reactivity to all tested LMWHs was established. We hypothesize that the degree of cross-reactivity might depend on the type of hypersensitivity reaction with immediate reactions linked to more extensive cross-reactivity than delayed reactions. This is important to consider because, at least in some cases, a safe alternative LMWH can be identified.
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Reacciones Cruzadas/inmunología , Heparina de Bajo-Peso-Molecular/efectos adversos , Hipersensibilidad/inmunología , Adulto , Femenino , Humanos , Pruebas CutáneasRESUMEN
Allergy to beta-lactam antibiotics is a common condition and about 10% of patients report being allergic to penicillin. However, this diagnosis is largely overestimated. Two types of allergy should be distinguished and include immediate hypersensitivity that can lead to anaphylactic shock and delayed hypersensitivity, ranging from the most common maculopapular exanthema to severe bullous toxidermia or life-threatening DRESS. Allergy challenge with oriented skin tests according to the clinical features, supplemented with oral challenge in the absence of contraindication, will confirm or invalidate the diagnosis of beta-lactam allergy and will help to identify if necessary safe alternatives to beta-lactams.
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Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas , beta-Lactamas/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/epidemiología , Exantema/diagnóstico , Exantema/epidemiología , Exantema/etiología , Humanos , Hipersensibilidad Tardía/diagnóstico , Hipersensibilidad Tardía/epidemiología , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/epidemiología , Pruebas CutáneasRESUMEN
INTRODUCTION: Antiepileptic drugs are widely used and are associated with numerous side effects including skin eruptions. Epicutaneous tests have been used with variable success in skin drug reactions. The purpose of this study was to evaluate the profitability of epicutaneous tests in delayed hypersensitivity reactions induced by antiepileptic drugs. METHODS: We analyzed all cases of allergic skin reactions to antiepileptic drugs notified in regional pharmacovigilance center of Sfax (Tunisia) between June 1, 2014 and April 30, 2016. The imputation score, determined using the French imputation method, should be at least doubtful. Patch-tests were performed in accordance with the general Europen network on Drug Allergy/European Academy of Allergy and Clinical Immunology (ENDA/EAACI) guidelines. Patch-tests were read according to the generally accepted criteria of the International contact dermatitis research group (ICDRG). RESULTS: In our study, 20 patients were included, among which 23 events were observed. The drug involved in delayed hypersensitivity reactions was carbamazepine in 11 cases, phenobarbital in 10 cases and valproic acid in 4 cases. The clinical reactions caused by the drug were classified as maculopapular exanthema (11 cases), DRESS syndrome (6 cases), Stevens-Johnson syndrome (2 cases), fixed drug eruption (2 cases) and erythroderma (2 cases). Patch-tests were positive in 19 patients (95 %). Cross-reactivity between antiepileptic drugs was observed in 4 cases: between valproic acid and carbamazepine in 2 cases between valproic acid and phenobarbital in 1 case and between phenobarbital and carbamazepine in 1 case. CONCLUSION: In this study, patch testing was a safe and useful method in confirming the culprit drug in delayed hypersensitivity reactions induced by antiepileptic drugs.
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Anticonvulsivantes/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad Tardía/inducido químicamente , Adolescente , Adulto , Anciano , Niño , Hipersensibilidad a las Drogas/diagnóstico , Femenino , Humanos , Hipersensibilidad Tardía/diagnóstico , Masculino , Persona de Mediana Edad , Pruebas del Parche , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Iodinated contrast media (ICM) are used extensively by both radiologists and cardiologists. Injection of such products can induce immediate hypersensitivity reactions, some of which are IgE-mediated, and delayed hypersensitivity reaction with all types of drug eruptions being reported. Allergy tests, whether patch-tests or intradermal tests, are useful to confirm whether patients are allergic. At the end of these tests, depending on the reaction (chronology and clinical symptoms) and the results of the skin tests, patients are given an allergy card as well as a detailed certificate indicating the various ICM contraindicated and those allowed. OBSERVATIONS: We report herein three cases of patients experiencing a confirmed allergic eruption after injection of ICM, and whose recommendations and contraindication were not taken into consideration, leading to recurrence of eruption after renewed ICM injection. DISCUSSION: The three cases we report herein underscore the lack of knowledge concerning eruptions induced by ICM, particularly among radiologists. Better dissemination of information about the existence of such reactions appears necessary amongst the medical professionals concerned.