Asunto(s)
Hipersensibilidad a las Drogas , Hipersensibilidad , Embarazo , Femenino , Humanos , Penicilinas/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/epidemiología , Hipersensibilidad a las Drogas/tratamiento farmacológico , Demografía , Hipersensibilidad/tratamiento farmacológico , Antibacterianos/efectos adversosRESUMEN
ABSTRACT: Antibiotics are frequently reported as allergies by patients, particularly antibiotics from the penicillin family. Most of these reported allergies are benign, and the consequences of alternative therapies can be significant. This article provides background information on penicillin allergies and serves as a guide to penicillin allergy management.Reprinted with permission from Wrynn, A.F. An overview of penicillin allergies for nurses. Nurse Pract 2022; 47(9): 30-36. Copyright Wolters Kluwer. All rights reserved.
Asunto(s)
Hipersensibilidad a las Drogas , Hipersensibilidad , Enfermeras y Enfermeros , Humanos , Antibacterianos/efectos adversos , Penicilinas/efectos adversos , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad/tratamiento farmacológicoRESUMEN
ABSTRACT: Antibiotics are frequently reported as allergies by patients, particularly antibiotics from the penicillin family. Most of these reported allergies are benign, and the consequences of alternative therapies can be significant. This article will deliver background information on penicillin allergies and serve as a guide to penicillin allergy management.
Asunto(s)
Hipersensibilidad a las Drogas , Penicilinas , Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas/tratamiento farmacológico , Humanos , Penicilinas/efectos adversosRESUMEN
INTRODUCTION: High-grade serous primary peritoneal cancer is highly sensitive to platinum-based chemotherapy with response rates above 80%. Incidence of immediate hypersensitivity reactions to carboplatin is estimated to be between 15% and 20%, usually seen after a mean of 6-8 infusions, with patients developing moderate to severe reactions. CASE REPORT: A 62-year-old female patient with stage IIIC primary high-grade serous carcinoma of the peritoneum was diagnosed and chemotherapy with carboplatin and Paclitaxel was indicated by the oncology service and patient shows response. At 6 months the patient returns, a new PET/CT reports progression of the disease. Carboplatin/paclitaxel cycles are restarted and in the eight cycle of carboplatin within 40 min of administration, she presented severe anaphylaxis with skin, pulmonary, cardiac and atypical symptoms. Infusion is suspended and intramuscular epinephrine with hydrocortisone and chlorphenamine are administered resolving symptoms. MANAGEMENT AND OUTCOME: Intradermal skin test with carboplatin at the concentration of 10 mg / ml (dilution 1: 100) was positive. Due to the symptoms presented and to continue the safe reintroduction to carboplatin, a 4 bag 16-step drug desensitization protocol was carried out at a total dose of 620 mg with no hypersensitivity reactions. DISCUSSION: Prolonged carboplatin use is associated with an increased incidence of carboplatin-related hypersensitivity reactions. And in patients that present hypersensitivity reactions, a safe and effective carboplatin desensitization protocol can be carried out to reach the administration of a full dose. Desensitization protocol induces tolerance to a drug temporarily and is dependent on continuous exposure.
Asunto(s)
Antineoplásicos , Hipersensibilidad a las Drogas , Neoplasias Ováricas , Neoplasias Peritoneales , Antineoplásicos/efectos adversos , Carboplatino/efectos adversos , Desensibilización Inmunológica/métodos , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/complicaciones , Paclitaxel , Neoplasias Peritoneales/tratamiento farmacológico , Tomografía Computarizada por Tomografía de Emisión de PositronesRESUMEN
INTRODUCTION: Allergic hypersensitivity reactions related to enzyme asparaginase may occur during intravenous infusion of drugs and other adverse reactions (non-allergic hypersensitivity and hyperammonemia), which do not require discontinuation of therapy as the first case. It makes differential diagnoses between infusion reactions essential to assure the team regarding the right decision to make after the adverse event. This study evaluated a pharmacovigilance strategy of differentiating infusion reactions to asparaginase in pediatric patients, based on the measurement of serum ammonia and the classification of the reactions by clinical symptoms and severity. METHODOLOGY: We included children, diagnosed with ALL, and treated with native Escherichia coli asparaginase in a university hospital. The professional team monitored and evaluated all asparaginase infusions for continuity of treatment (rechallenge), seeing the measurement of serum ammonia and classification of reactions for type and severity grade. Data from this monitoring was collected retrospectively. Chi-square and Mann-Whitney tests were used to compare the ratios between serum ammonia concentration posterior and before asparaginase infusion. RESULTS: 245 infusions in 32 patients were monitored, and 19 reactions were observed in 17 children (53%). Three children have hyperammonemia and continue their treatment. The variation of the serum ammonia levels before and after the infusion was statistically significant, comparing the groups with no reaction or hyperammonemia versus the group with the hypersensitivity reaction. CONCLUSION: The pharmacovigilance strategy applied in the hospital investigated was a useful and inexpensive tool that supported clinical decision-making and enabled the maintenance of asparaginase therapy for three (9,4%) patients followed up.
Asunto(s)
Antineoplásicos , Hipersensibilidad a las Drogas , Hiperamonemia , Leucemia-Linfoma Linfoblástico de Células Precursoras , Amoníaco/uso terapéutico , Antineoplásicos/efectos adversos , Asparaginasa/efectos adversos , Niño , Hipersensibilidad a las Drogas/tratamiento farmacológico , Humanos , Hiperamonemia/inducido químicamente , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Estudios RetrospectivosAsunto(s)
Asma Inducida por Aspirina , Hipersensibilidad a las Drogas , Sinusitis , Antiinflamatorios no Esteroideos , Aspirina/efectos adversos , Asma Inducida por Aspirina/tratamiento farmacológico , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/tratamiento farmacológico , HumanosRESUMEN
Context: Ketoprofen is widely used to remove pain. A steady increase on allergic reactions and photoallergic contact dermatitis related to ketoprofen has been reported when there is topical use. However, there are few documented cases of hypersensitivity when it is administered systemically.Objective: Present a case of hypersensitivity reaction after systemic administration of ketoprofen for pain control in nephritis crisis.Case description: A 43-years-old Caucasian man diagnosed with renal colic (kidney lithiasis), who was initially treated with 100 mg of tramadol (IV), followed by 4 mg of thiocolchicoside (IM) which caused no relief. Then 100 mg of ketoprofen was administered (IV). Right after the patient began to show hypersensitivity reaction type I characterized by intense coughing, rhinitis, angioedema, periorbital edema, rash, and scleral jaundice.Discussion and conclusion: Maybe it was a case of drug-induced liver disease, however therapeutic dosages of all administered drugs only once. The mechanisms involved were not investigated, but may be the result of allergic and immunologic aspects caused by ketoprofen and facilitated by a history of hypersensitivity to other NSAIDs as reported by the patient. As for jaundice can be attributed to drug toxicity since laboratory parameters did not reveal any evidence of liver disease.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad Inmediata/inducido químicamente , Cetoprofeno/efectos adversos , Adulto , Antiinflamatorios no Esteroideos/administración & dosificación , Antiinflamatorios no Esteroideos/uso terapéutico , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Humanos , Hipersensibilidad Inmediata/diagnóstico , Hipersensibilidad Inmediata/tratamiento farmacológico , Cetoprofeno/administración & dosificación , Cetoprofeno/uso terapéutico , Masculino , Dolor/tratamiento farmacológico , Resultado del TratamientoRESUMEN
Los antiinflamatorios no esteroideos son ampliamente recetados en niños. Constituyen la segunda causa de reacciones a medicamentos en pediatría después de los antibióticos betalactámicos; sin embargo, solo una parte de estas son reacciones de hipersensibilidad. La prevalencia de dichas reacciones a antiinflamatorios no esteroideos en niños es del 0,3 % y aumenta al 5 % en asmáticos.Los mecanismos fisiopatológicos involucrados (inhibición de la ciclooxigenasa, hipersensibilidad mediada por inmunoglobulina E, linfocitos T reactivos y/o afectación de la inmunidad innata) darán lugar a diferentes entidades clínicas con sintomatología dispar.La confusión con síntomas propios de procesos virales y la variabilidad clínica hacen del diagnóstico de certeza un verdadero desafío. Una historia clínica detallada, análisis de laboratorio, pruebas cutáneas y de provocación controlada permitirán definir estrategias para cada paciente en particular sin etiquetar como alérgico a un niño que no lo es ni exponer a riesgos innecesarios a quien está sensibilizado.
Nonsteroidal anti-inflammatory drugs are widely prescribed in children. They are the second cause of drug Ìs reactions in pediatrics after beta-lactam antibiotics, however only a part of them are hypersensitivity reactions. The prevalence of these reactions to nonsteroidal anti-inflammatory drugs in children is 0.3 %, increasing to 5 % in asthmatics.The different physiopathological mechanisms involved (inhibition of cyclooxygenase, immunoglobulin E-mediated hypersensitivity, reactive T lymphocytes and/or disturbance of innate immunity) will cause different clinical entities with diverse symptoms.The confusion between the common symptoms of a viral infection and a hypersensitivity reaction, and the variability of the clinical presentations make diagnosis a real challenge.A detailed clinical history, laboratory, skin and controlled provocation tests will provide strategies for each patient, without labeling a child who is not an allergic one, or taking unnecessary risks with those who are sensitized.
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Antiinflamatorios no Esteroideos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Pruebas Cutáneas , Reacciones Cruzadas , Hipersensibilidad a las Drogas/prevención & controlRESUMEN
The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times - the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.
Asunto(s)
Desensibilización Inmunológica/métodos , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Anciano , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Humanos , Masculino , Sulfametoxazol/efectos adversos , Trimetoprim/efectos adversosRESUMEN
ABSTRACT The fixed drug eruption is a non-immediate hypersensitivity reaction to drug, characterized by recurrent erythematous or violaceous, rounded, well-defined border plaques, which always appear in the same location every time the culprit drug is administered. The usual practice is to avoid the drug involved and to use a structurally different drug. However, there are situations in which there is no safe and effective therapy. In such situations, desensitization is the only option. We describe the case of a patient who presented fixed eruption due to sulfamethoxazole-trimethoprim, who underwent successful desensitization, but required a repeat procedure twice due to relapse after inadvertent full-dose reintroduction. In non-immediate hypersensitivity reaction to drug, the indication is controversial and there is no technical standardization. Furthermore, the time at which such tolerance is lost after discontinuing the drug involved is unknown. In severe non-immediate reactions of types II and III, desensitization is contraindicated. The patient underwent desensitisation to sulfamethoxazole-trimethoprim three times − the first with recurrence of lesions and the second and third without manifestations, all concluded successfully and with no premedication.
RESUMO A erupção fixa por drogas é uma reação de hipersensibilidade a medicamento não imediata, caracterizada por placas eritematosas ou violáceas, arredondadas, recorrentes, de bordas bem definidas e que aparecem sempre na mesma localização cada vez que o medicamento culpado é administrado. A prática habitual é evitar a droga envolvida e utilizar um medicamento estruturalmente diferente. Contudo, há situações em que não há terapêutica segura e eficaz. Em tais situações, a dessensibilização é a única opção. Descrevemos o caso de um paciente que apresentou erupção fixa por drogas por sulfametoxazol-trimetoprim, tendo sido submetido à dessensibilização com sucesso, mas necessitou repetição do procedimento duas vezes, por recidiva da reação após reintrodução inadvertida em dose plena. Em reação de hipersensibilidade a medicamento não imediata, a indicação é controversa e não há padronização técnica. Além disso, não se conhece o tempo durante o qual essa tolerância é perdida após a suspensão da droga envolvida. Nas reações não imediatas graves e dos tipos II e III, a dessensibilização está contraindicada. O paciente foi submetido a dessensibilização ao sulfametoxazol-trimetoprim por três vezes − a primeira com recorrência de lesões, e a segunda e terceira sem manifestações, sendo todas concluídas com sucesso e sem uso de pré-medicação.
Asunto(s)
Humanos , Masculino , Anciano , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Desensibilización Inmunológica/métodos , Erupciones por Medicamentos/etiología , Erupciones por Medicamentos/tratamiento farmacológico , Sulfametoxazol/efectos adversos , Trimetoprim/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad a las Drogas/tratamiento farmacológicoRESUMEN
BACKGROUND: Allopurinol is a xanthine oxidase inhibitor used in the treatment of patients with gout. Approximately 2% of patients are affected by adverse reactions to this drug. Severity ranges from mild rashes to severe reactions in up to 0.4% of cases. De-sensitization is carried out by administering increasing doses of the drug. CASE REPORT: Thirty-year old man diagnosed with hypercholesterolemia and hypertriglyceridemia treated with bezafibrate and pravastatin, systemic arterial hypertension treated with losartan and a 10-year history of hyperuricemia with gout. Tophi were found in metacarpophalangeal joints and elbows. Treatment was started with allopurinol 300 mg/day. Two weeks later, he experienced facial erythema with itching and maculopapular lesions on the malar region 1 hour after the medication was ingested. An outpatient drug de-sensitization protocol was initiated, starting with 5 mg, and with gradual dose increases every 4 to 5 days for 59 days until the desired maintenance dose (300 mg) was reached. CONCLUSIONS: Experience shows that de-sensitization to allopurinol is a safe alternative when there is hypersensitivity and treatment with this drug is required.
Antecedentes: El alopurinol es un inhibidor de la xantinooxidasa usado en el tratamiento de pacientes con gota. Aproximadamente 2 % de los pacientes son afectados por reacciones adversas a dicho fármaco. La severidad varía de erupciones cutáneas leves a reacciones graves hasta en 0.4 % de los casos. La desensibilización se lleva a cabo incrementando paulatinamente la dosis del fármaco. Reporte de caso: Hombre de 30 años con diagnóstico de hipercolesterolemia e hipertrigliceridemia tratadas con bezafibrato y pravastatina, hipertensión arterial sistémica tratada con losartán e hiperuricemia con gota de 10 años de diagnóstico. Los tofos se encontraban en articulaciones metacarpofalángicas y codos. Se inició tratamiento con 300 mg diarios de alopurinol, a las dos semanas el paciente presentó eritema facial con prurito y lesiones maculopapulares en región malar una hora después de la ingesta del medicamento. Se inició protocolo ambulatorio de desensibilización a dicho fármaco comenzando con 5 mg, con incremento gradual de la dosis cada cuatro o cinco días por 59 días, hasta llegar a la dosis de mantenimiento deseada (300 mg). Conclusiones: La experiencia muestra que la desensibilización a alopurinol es una alternativa segura cuando existe hipersensibilidad y necesidad de tratamiento con este fármaco.
Asunto(s)
Alopurinol/efectos adversos , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Supresores de la Gota/efectos adversos , Gota/tratamiento farmacológico , Adulto , Alopurinol/uso terapéutico , Supresores de la Gota/uso terapéutico , Humanos , MasculinoRESUMEN
PURPOSE OF REVIEW: The present review addresses the epidemiology, analyzes the current data and promotes global awareness of drug-induced anaphylaxis. RECENT FINDINGS: Anaphylaxis is a medical emergency that may cause death! In the last decade, studies have shown an increasing incidence and prevalence of anaphylaxis. SUMMARY: Drug-induced anaphylaxis fatalities have increased, and this syndrome remains underdiagnosed and undertreated.
Asunto(s)
Anafilaxia/epidemiología , Hipersensibilidad a las Drogas/epidemiología , Epidemias , Anafilaxia/tratamiento farmacológico , Brasil , Hipersensibilidad a las Drogas/tratamiento farmacológico , Epinefrina/uso terapéutico , Humanos , Incidencia , Guías de Práctica Clínica como Asunto , PrevalenciaRESUMEN
Abstract We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20 min after the dye injection, the patient developed hypotension (BP = 70 × 30 mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2 h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.
Resumo Os autores apresentam um caso de reação alérgica ao azul patente em uma paciente submetida à exérese de linfonodo em sentinela associada a uma ressecção segmentar de mama. Paciente apresentou aproximadamente pós 20 minutos da injeção do corante hipotensão (PA = 70 × 30 mmHg) associada a aumento da frequência cardíaca. Foi tratada satisfatoriamente com diminuição da fração inspirada do anestésico inalatório e reposição volêmica. No fim do procedimento apresentava placas urticariformes azuladas em cabeça, pescoço, membros superiores e tronco e foi usada hidrocortisona. Evoluiu, sem intercorrências, na sala de recuperação pós-anestésica e teve alta duas horas após o término do procedimento cirúrgico sem a presença das alterações cutâneas. Alta hospitalar na manhã seguinte à cirurgia. A incidência de reações alérgicas com o emprego do azul patente é muito superior às reações de hipersensibilidade observadas com drogas anestésicas e adjuvantes. Portanto, o anestesiologista deve ficar atento à instabilidade cardiovascular associada a alterações cutâneas quando do uso do azul patente para o diagnóstico precoce e tratamento adequado dessa reação de hipersensibilidade com o emprego do corante.
Asunto(s)
Humanos , Femenino , Colorantes de Rosanilina/efectos adversos , Mama/cirugía , Hidrocortisona/uso terapéutico , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Colorantes/efectos adversos , Urticaria/complicaciones , Urticaria/tratamiento farmacológico , Hipersensibilidad a las Drogas/complicaciones , Persona de Mediana Edad , Antiinflamatorios/uso terapéuticoRESUMEN
We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.
Asunto(s)
Mama/cirugía , Colorantes/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hidrocortisona/uso terapéutico , Colorantes de Rosanilina/efectos adversos , Antiinflamatorios/uso terapéutico , Hipersensibilidad a las Drogas/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Urticaria/complicaciones , Urticaria/tratamiento farmacológicoRESUMEN
UNLABELLED: Botulinum toxin is a widely used treatment with satisfactory results, and it is relatively safe in the doses used for cosmetic procedures. The authors report a case of allergic reaction to Chinese botulinum toxin serotype A (CBTX-A). Although this is a rare adverse event, it is nonetheless clinically relevant to healthcare professionals. A 44-year-old woman presented to the authors' hospital complaining of dynamic wrinkles. CBTX-A was used to treat her. Minutes after application, she developed urticarial plaques proximal to the injection site. The patient had an allergic reaction, as documented by a positive skin test, which was controlled by the administration of antihistamines and systemic corticosteroids. This report is intended to guide healthcare professionals faced with this type of adverse event regarding how to proceed without hindering the delivery and effectiveness of the treatment. When performed by a qualified health professional, this treatment brings excellent results in the vast majority of cases. LEVEL OF EVIDENCE: 5 Risk.
Asunto(s)
Toxinas Botulínicas Tipo A/efectos adversos , Técnicas Cosméticas/efectos adversos , Hipersensibilidad a las Drogas/etiología , Fármacos Neuromusculares/efectos adversos , Envejecimiento de la Piel/efectos de los fármacos , Urticaria/inducido químicamente , Corticoesteroides/administración & dosificación , Adulto , Toxinas Botulínicas Tipo A/administración & dosificación , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Femenino , Antagonistas de los Receptores Histamínicos/administración & dosificación , Humanos , Inyecciones Intramusculares , Pruebas Intradérmicas , Fármacos Neuromusculares/administración & dosificación , Inducción de Remisión , Factores de Tiempo , Resultado del Tratamiento , Urticaria/diagnóstico , Urticaria/tratamiento farmacológicoRESUMEN
Biological agents are used in the treatment of neoplastic, autoimmune, and inflammatory diseases and their clinical applications are becoming broader. Following their increased utilization, hypersensitivity reactions linked to these drugs have become more frequent, sometimes preventing the use of first-line therapies. The clinical presentation of hypersensitivity reactions to biological agents ranges from mild cutaneous manifestations to life-threatening reactions. In this scenario, rapid desensitization is a groundbreaking procedure that enables selected patients to receive the full treatment dose in a safe way, in spite of their immediate hypersensitivity reaction to the drug, and protects them against anaphylaxis. The aim of this review is to update and discuss some of the main biological agents used in clinical practice (rituximab, trastuzumab, cetuximab, ofatumumab, tocilizumab, brentuximab, omalizumab, and tumor necrosis factor alpha inhibitor agents) and their associated hypersensitivity reactions, including clinical presentations, diagnosis, and treatment in the acute setting. In addition, novel management options with rapid desensitization are presented.
Asunto(s)
Factores Biológicos/efectos adversos , Hipersensibilidad a las Drogas , Desensibilización Inmunológica , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/terapia , HumanosRESUMEN
It has been recognized that a high proportion of chronic urticaria patients experience symptom aggravation when exposed to aspirin and NSAIDs. This clinical picture is known as Aspirin-exacerbated cutaneous disease. The pathogenesis of these exacerbations is related to the inhibition of cyclooxygenase-1 leading to a decreased synthesis of PGE2 and an increased cysteinyl leukotriene production in the skin and subcutaneous tissues. Patient management comprises the treatment of the underlying cutaneous disease with nonsedating antihistamines and other medications, avoidance of COX-1 inhibitors, and the use of alternative NSAIDs that do not inhibit COX-1 for the relief of pain, inflammation and fever.
Asunto(s)
Antiinflamatorios no Esteroideos/efectos adversos , Aspirina/efectos adversos , Enfermedades de la Piel/etiología , Antiinflamatorios no Esteroideos/farmacología , Aspirina/farmacología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/etiología , Humanos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/tratamiento farmacológicoRESUMEN
We report a case of sudden unexpected death in an adult woman from florid myocarditis with necrosis, replacement fibrosis, and diffuse infiltration of the myocardium by eosinophils and conspicuous giant cells. Clinical history revealed that 3 weeks prior to death, shortly after commencing antibiotic therapy for the treatment of traumatic wound of a finger, she presented to the emergency room with a hypersensitivity reaction characterized by facial rash with edema and generalized pruritus. She was treated with antihistamines and discharged. The clinico-pathological correlation suggests a link between drug hypersensitivity and the giant cell myocarditis.
Asunto(s)
Amoxicilina/efectos adversos , Antibacterianos/efectos adversos , Muerte Súbita/etiología , Hipersensibilidad a las Drogas/etiología , Células Gigantes/patología , Miocarditis/inducido químicamente , Miocardio/patología , Adolescente , Autopsia , Causas de Muerte , Muerte Súbita/patología , Hipersensibilidad a las Drogas/tratamiento farmacológico , Hipersensibilidad a las Drogas/patología , Resultado Fatal , Femenino , Antagonistas de los Receptores Histamínicos/uso terapéutico , Humanos , Miocarditis/patologíaRESUMEN
The DRESS (drug rash, eosinophilia and systemic symptoms) syndrome, also known as DIHS (drug-induced hypersensitivity syndrome), is a severe idiosyncratic reaction to several drugs, mainly antiepileptics and antibiotics, which can occasionally produce acute liver failure. In this article we present two cases of the DRESS syndrome presenting with severe acute hepatitis, including the first case of DRESS associated with levetiracetam. Although both cases finally resolved with good outcomes, DRESS can lead to acute liver failure and has a bad prognosis when liver damage is present. Rapid diagnosis is crucial since withdrawal of the offending drug is the key of treatment, while the potential role of corticosteroids is discussed.