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INTRODUCTION: In prostate cancer, androgens are key in the growth of both normal prostate and cancer cells. Abiraterone acetate inhibits CYP17, an important target in prostate cancer given its central role in the production of adrenal and tumor-derived androgens. Although abiraterone is generally well tolerated, common adverse effects such as hypertension, hypokalemia, and hepatotoxicity have been reported. CLINICAL CASE: We present the case of an 83-year-old Mexican man with high-volume EC IV prostate cancer resistant to castration, orchiectomy, and bone, liver, and lung metastases. First-line treatment with the CHAARTED scheme was indicated, by patient decision refuse chemotherapy treatment. On the fourth day of starting treatment, he developed pruritic erythematous macular skin lesions and urticaria on the posterior chest that resolved spontaneously. A generalized erythematous and pruritic maculopapular rash appeared 12 days after starting abiraterone, for which she was referred to allergies. MANAGEMENT AND RESULTS: An oral provocation test was performed for two days, presenting localized macular lesions eight hours after the administration of abiraterone. An oral desensitization protocol was carried out for ten days in which no hypersensitivity reactions were observed, thus achieving the successful administration of abiraterone.
Assuntos
Androstenos , Dessensibilização Imunológica , Hipersensibilidade a Drogas , Neoplasias da Próstata , Humanos , Masculino , Idoso de 80 Anos ou mais , Neoplasias da Próstata/tratamento farmacológico , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/etiologia , Androstenos/uso terapêutico , Androstenos/efeitos adversos , Androstenos/administração & dosagem , Antineoplásicos/efeitos adversos , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológicoRESUMO
OBJECTIVE: To characterize demographically and clinically the patients with anaphylaxis treated in a third level health institution in Medellin, Colombia. METHODS: A cross-sectional descriptive observational study was carried out, which includedpatients were diagnosed with anaphylaxis between 2009 and 2019. Information was retrieved from medical records through a collection instrument. Subsequently, a descriptive statistical analysis of proportions and measures of central tendency of the variables of interest was performed. RESULTS: A total of 1820 records were reviewed and data from 253 patients were included. Among the reported comorbidities, drug allergy was the most prevalent (28%). The most frequent manifestations of anaphylaxis were cutaneous and respiratory. Most of the cases presented basal tryptase values ≤ 11.4 ng/mL (94.7%). Different etiological agents (food, drugs, insects and latex) were reported, and their frequency varied according to age. Adrenaline, steroids, and antihistamines were the treatments of choice in 39.9, 34.3, and 39.9% of cases, respectively. CONCLUSIONS: The characteristics of anaphylaxis in a medical center in Colombia coincide with those reported in Latin American. The treatment of anaphylaxis is not standardized, which makes it necessary to educate the health personnel and develop national guidelines.
OBJECTIVO: Identificar las características clínicas y demográficas de pacientes con anafilaxia, atendidos en un hospital de tercer nivel de Medellín, Colombia. MÉTODOS: Estudio observacional, descriptivo, de corte transversal, al que se incluyeron pacientes con diagnóstico con anafilaxia entre 2009 y 2019. La información de los pacientes se obtuvo a partir de los expedientes clínicos, mediante un instrumento de recolección. Se realizó un análisis estadístico descriptivo, de proporciones y medidas de tendencia central de las variables de interés. RESULTADOS: Se revisaron 1820 expedientes y se incluyeron los datos de 253 pacientes. Los agentes etiológicos más frecuentes fueron: medicamentos (52.1%), alimentos (34.7%), picadura de insectos (13.8%) y agentes no especificados (17.7%). Las manifestaciones cutáneas y respiratorias fueron las más frecuentes asociadas con anafilaxia. El 94.7% de los casos tuvo concentraciones normales de triptasa. La adrenalina, los corticosteroides y antihistamínicos fueron los fármacos de elección en el 39.9, 34.3 y 39.9% de los casos, respectivamente. CONCLUSIONES: Las características de anafilaxia coinciden con las reportadas en la mayor parte de los estudios en Latinoamérica. Aunque existen guías mundiales de tratamiento de la anafilaxia, no suelen aplicarse de forma uniforme, lo que hace necesario adiestrar al personal de salud y desarrollar guías nacionales al respecto.
Assuntos
Anafilaxia , Humanos , Anafilaxia/diagnóstico , Centros de Atenção Terciária , Colômbia/epidemiologia , Estudos Transversais , Epinefrina/uso terapêutico , Alérgenos/uso terapêuticoRESUMO
Abstract Background: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. Objective: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. Method: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. Results: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. Study limitations: Retrospective study. Conclusion: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.
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BACKGROUND: Any substance used as a treatment for any disease can produce harmful or unpleasant events called adverse drug reactions (ADRs). They are due to inherent biological effects of the drug and are caused by immunological and non-immunological mechanisms. OBJECTIVES: To describe the immunological mechanisms of hypersensitivity reactions (HSR) to drugs, their epidemiology, risk factors, classification, clinical manifestations, diagnosis, treatment, and prognosis. METHODS: A review of the most current literature in English and Spanish was carried out, in the main databases, related to the HSR of various drug groups. RESULTS: This study describes the terms used to define ADRs and HSRs, their classification and clinical manifestations, current diagnostic tools, treatment algorithms and prognosis of the most frequently used medications and with the highest prevalence of reported adverse events. CONCLUSION: ADRs are a challenging entity, with a complex pathophysiology that has not been fully understood. Its approach requires a careful consideration since not all drugs have validated tests for their diagnosis nor a specific treatment. When indicating the use of any drug, the severity of the disease, the availability of other treatments and the potential risks of developing future adverse events should always be taken into consideration.
ANTECEDENTES: Cualquier sustancia prescrita en el tratamiento de algún padecimiento es capaz de producir eventos dañinos o desagradables, y se denominan reacciones adversas a medicamentos. Estas reacciones se originan por mecanismos inmunológicos y no inmunológicos. OBJECTIVOS: Describir los mecanismos inmunológicos de las reacciones de hipersensibilidad a medicamentos, epidemiologia, factores de riesgo, clasificación, manifestaciones clínicas, diagnóstico, tratamiento y pronóstico. MÉTODOS: Se revisó la bibliografía actualizada, en inglés y español, asociada con reacciones de hipersensibilidad a medicamentos en las principales bases de datos. RESULTADOS: Se describen los términos para definir las reacciones adversas y de hipersensibilidad a medicamentos, su clasificación y manifestaciones clínicas, métodos diagnósticos actuales y en estudio, algoritmos de tratamiento y pronóstico de los medicamentos más frecuentemente prescritos y con mayor prevalencia de eventos adversos reportados. CONCLUSIÓN: Las reacciones adversas a medicamentos representan un reto, con una fisiopatología compleja y no del todo comprendida. Su abordaje requiere un enfoque cuidadoso, porque no todos los fármacos cuentan con pruebas validadas para establecer el diagnóstico y tratamiento específico. Antes de indicar cualquier medicamento debe considerarse la gravedad de la enfermedad, disponibilidad de otros tratamientos y riesgos potenciales de sufrir eventos adversos.
Assuntos
Hipersensibilidade a Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Humanos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/terapia , Hipersensibilidade a Drogas/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , PrevalênciaRESUMO
BACKGROUND: Neomycin is used in several over-the-counter pharmaceutical formulations in Brazil. In Europe and Canada, where it is not freely available, its sensitization frequency is lower than in the United States, where this does not occur. OBJECTIVE: To present the frequency of sensitization to neomycin observed in a tertiary hospital and the pharmaceutical formulations sold in Brazil containing neomycin. METHOD: Retrospective analysis of positive results to neomycin, obtained through patch tests performed in a tertiary hospital, from 2009 to 2018 and investigation of topical drugs and vaccines containing neomycin in Brazilian databases available on the internet. RESULTS: Among 1,162 patients, 71 (6%) had positive reactions to neomycin, 65% female and 35% male individuals, 46% were over 50 years old, and 24% had a personal history of atopy. The dermatitis lasted from four months to 20 years. Lesions were located in 69% of the patients on the upper limbs, in 55% they were on the lower limbs, and in 42% they were disseminated in more than 4 sites. Polysensitization was detected in 55% of cases. Of these, 28% were linked to sensitization to rubber allergens and 27% to potassium bichromate. A total of 158 topical presentations of neomycin were found: 79 ointments, 58 creams, 10 ophthalmic solutions, seven otological solutions, one oral solution, two nasal solutions, and one antiseptic powder, in addition to 11 types of vaccines. STUDY LIMITATIONS: Retrospective study. CONCLUSION: Sensitization to neomycin occurred in 6% of the studied population, affecting more females aged over 50 years, with skin lesions located mainly on the upper and lower limbs, in the context of chronic contact dermatitis. Neomycin was found in 135 formulations, most of them available over the counter, as well as in 11 miscellaneous vaccines.
Assuntos
Dermatite Alérgica de Contato , Neomicina , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Neomicina/efeitos adversos , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/epidemiologia , Estudos Retrospectivos , Alérgenos/efeitos adversos , Testes do Emplastro/métodos , Preparações FarmacêuticasRESUMO
Summary: Background. Severe cutaneous adverse reactions (SCAR) are potentially fatal reactions. Genetic predisposition is involved in their pathogenesis related to drugs and ethnicities, however in a mixed population these relationships are still unknown. The aim of this study was to describe phenotypes, suspect drugs and HLA-alleles related to SCAR, identified by a systematized approach in a Brazilian case series. Methods. Patients who were diagnosed with SCAR between March 2011 and July 2019 at our university hospital were included. European Network for Drug Allergy (ENDA) questionnaire was used to collect clinical and laboratory data and algorithms for assessment of drug causality were applied. Socio-demographic variables included age, gender and skin color/ethnicity. Drug patch tests (DPT) and HLA-A, -B, -DRB1 typing were carried out. Results. A total of 74 patients were included: 36 (48.64%) with SJS/TEN, 32 (43.24%) DRESS/DIHS, 3 (4.05%) AGEP, 2 (2.70%) overlap(DRESS/SJS and DRESS/AGEP) and 1 (1.35%) GBFDE. The median age was31.5 years (IQR = 14-52.25), most were female (n = 44/59.46%) and brown (n = 38/51.35%). Anticonvulsants (n = 32/43.24%) were the largest group involved and antibiotics (n = 26/35.13%) were the second most common. Two patients with DRESS died during the acute phase. Positive DPT were shown only in anticonvulsant associated DRESS. HLA related to abacavir, allopurinol and carbamazepine were identified. Conclusions. A systematized approach allowed the phenotypic characterization of SCAR. The HLA-A*31:01, B*57:01 and B*58:01 alleles were identified, reinforcing the causality in SCAR by CBZ, ABC and ALLO in the Brazilian population.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Síndrome de Stevens-Johnson , Anticonvulsivantes/efeitos adversos , Brasil , Carbamazepina , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Feminino , Antígenos HLA-A/genética , Humanos , Masculino , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/genéticaRESUMO
BACKGROUND: The frequency of allergic diseases in tropical Latin American populations is poorly understood, and certain particularities can impact their natural history and risk factors. OBJECTIVE: The study aimed to determine the frequency of self-reported allergies (allergic diseases, drug, and food allergies) in patients who attended the Hospital Universitario Fundación Santa Fe de Bogotá, Colombia. MATERIAL AND METHODS: A retrospective study was conducted to assess the frequency of self- reported allergies reported by all the patients who attended an allergy referral center between June and December 2019. RESULTS: A total of 60978 patients were included. Allergic rhinitis was reported by 1.51% (n = 921), asthma by 1.28% (n = 782), and atopic dermatitis by 0.41% (n = 250) of the study population. A higher frequency of self-reported allergic diseases (rhinitis, asthma, and dermatitis) was found in the younger populations, while drug allergies were more frequently reported in adults. The most frequently self-reported drug allergies were penicillin allergy (4.07%, n = 2479), and non- steroidal anti-inflammatory drug (NSAID) allergy (1.85%, n = 1116). The most commonly reported food allergens included shellfish (0.58%), fruits (0.54%), cow's milk protein (0.37%), and eggs (0.21%). CONCLUSION: The distribution of food allergens showed a higher frequency of shrimp and fruit allergies compared to previous studies on African, Asian, and Arabic tropical populations that describe a higher predominance of egg and milk allergies. Patients reporting allergic diseases should always be referred to the allergology department for confirmatory testing.
Assuntos
Asma , Hipersensibilidade a Drogas , Hipersensibilidade Alimentar , Preparações Farmacêuticas , Alérgenos , Animais , Bovinos , Colômbia/epidemiologia , Feminino , Hospitais , Humanos , América Latina , Encaminhamento e Consulta , Estudos Retrospectivos , AutorrelatoRESUMO
OBJECTIVE: To evaluate the costs associated with evaluation of ß-lactam allergy in children labeled as allergic. STUDY DESIGN: We performed a prospective year-long real life observational study designed to evaluate all pediatric patients with suspected ß-lactam allergy who consulted for allergy evaluation. Direct and indirect costs were systematically recorded. Direct healthcare costs were calculated by taking into account the number of visits and all complementary and diagnostic tests performed. Direct nonhealthcare costs were calculated by considering the number of visits and the kilometers from their homes to the clinic. Finally, indirect costs were evaluated by considering the absenteeism of parents or other companions who took the children to the clinic. RESULTS: A total of 40 children with suspected allergy to ß-lactams were evaluated in our outpatient clinic from June 1, 2017 to May 31, 2018. Total direct healthcare costs were $5038.03, with an average cost per patient of $125.95. Direct nonhealthcare costs reached $901.87 ($22.55 per patient) and indirect nonhealthcare costs reached $6384.35 ($159.61 per patient). The total cost was $12 324.25, a cost of $308.11 per patient. CONCLUSIONS: Elective evaluation of ß-lactam allergy and delabeling children who are not allergic is not expensive. In addition, it could save future expenses because of an unnecessary lifelong use of alternative antibiotics that are usually more expensive, less effective, and more frequently associated with antimicrobial resistance and different side effects.
Assuntos
Antibacterianos/administração & dosagem , Hipersensibilidade a Drogas/diagnóstico , beta-Lactamas/efeitos adversos , Criança , Análise Custo-Benefício , Hipersensibilidade a Drogas/economia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Estudos Prospectivos , Testes Cutâneos/economiaRESUMO
Summary: Drug allergies are developed by antibody or cell-mediated reactions as immunologic mechanisms. It has been demonstrated that hypersensitivity reaction to certain allergens may play a role in the pathogenesis of inflammatory bowel disease (IBD) focused on food allergies. A total of 256 patients with UC were divided in two groups: 203 patients with active UC and 53 in remission UC were included in the present study. In the present study we found that 11.7% had allergy to at least one drug distributed. The most frequent drug-allergies were sulfonamides in 2.8% and penicillin in 3.1%. Sulfonamide allergy was associated with several extraintestinal manifestations such as: peripheral arthritis/arthralgia (OR = 9.06, 95% CI 1.71 - 48.00, p = 0.002); pyoderma gangrenosum (OR = 24.10, 95% CI 3.55 - 163.48, p minor 0.0001) and uveitis (OR = 15.93, 95% CI 2.55 - 99.23, p minor 0.0001). The frequency of drug allergy was 11.7% in Mexican UC patients, most frequently to sulfonamides and penicillin drugs. The presence of sulfonamide allergy was associated with the presence of several extra-intestinal manifestations.
Assuntos
Alérgenos/efeitos adversos , Colite Ulcerativa/imunologia , Hipersensibilidade a Drogas/imunologia , Penicilinas/efeitos adversos , Sulfonamidas/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alérgenos/imunologia , Artrite , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/imunologia , Pioderma Gangrenoso , Sulfonamidas/imunologia , Uveíte , Adulto JovemRESUMO
Background: Pharmacodermia is defined as adverse reaction in skin, mucosa and appendages, which generates morphofunctional alterations in cutaneous barrier, inducing autoimmune diseases, such as pemphigus foliaceous, which is known asthe most common autoimmune skin disease in dogs. This disease involves autoantibodies against desmoglein and desmocolinmolecules, being induced by the use of certain drugs. Mupirocin (pseudomonic acid A) is a broad-spectrum antibiotic withbacteriostatic activity, being effective against Gram-positive pathogens and used to control superficial bacterial folliculitis.Based on that, the aim of this study was to report a pemphigus-like lesions after topical use of mupirocin in dog.Case: An 1-year-old, uncastrated male, Poodle dog, weighing 13.8 kg was treated in a private clinic in Fortaleza. The maincomplaint was related to pruritus in abdominal and inguinal region, in addition of legs licking. Dermatological examination revealed melanic crusts, epidermal collars and diffuse pustules in inguinal, abdominal, perianal and thoraco-lumbarregions. The therapy was based on topical use of Mupirocin in form of 0.2% aquous spray. After drug administration, theanimal presented urticaria, diffuse epidermal collars, papulo-crusted and pustular lesions, which were more evident inabdominal and inguinal region. Nasal erythema, binocular blepharitis, apathy and fever were also observed. Cytologicalexamination and bacterial culture were performed, revealing inflammatory and acantholytic cells and no bacterial growth.Biopsy procedure revealed subcorneal pustule with presence of epithelial acantholytic cells and neutrophils, compatiblewith canine pemphigus foliaceous. The topical treatment of ocular lesions with 0.1% Tacrolimus associated with systemictreatment with high dose of prednisolone (1.2 mg kg-1)...(AU)
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Animais , Cães , Mupirocina/efeitos adversos , Pênfigo/etiologia , Pênfigo/veterinária , Toxidermias/terapia , Toxidermias/veterinária , Doenças Autoimunes/veterináriaRESUMO
PURPOSE OF REVIEW: The aim of this study is to critically review the relevant literature published on basophil activation test, presenting the current knowledge and future perspectives. RECENT FINDINGS: Basophil activation test (BAT) results varied accordingly to the class of the drug studied, and have promising results in immediate hypersensitivity reactions to pyrazolone (selective reactors), neuromuscular blockers, beta-lactams, and platinum compounds, all examples of classical IgE-mediated hypersensitivity drug reactions. Currently, BAT is applied in research settings, but based in the results of our review, the test can be considered as a diagnostic tool for daily practice for selected patients and selected drugs, when the test is available, particularly for patients who experienced severe reactions and when diagnosis cannot be stablished by serum-specific IgE and skin testing, in order to avoid unnecessary drug provocations tests.
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Teste de Degranulação de Basófilos , Basófilos/imunologia , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Imediata/induzido quimicamente , Anti-Inflamatórios não Esteroides/efeitos adversos , Humanos , Hipersensibilidade Imediata/diagnóstico , Fármacos Neuromusculares/efeitos adversos , Pirazolonas/efeitos adversos , beta-Lactamas/efeitos adversosRESUMO
Background: Pharmacodermia is defined as adverse reaction in skin, mucosa and appendages, which generates morphofunctional alterations in cutaneous barrier, inducing autoimmune diseases, such as pemphigus foliaceous, which is known asthe most common autoimmune skin disease in dogs. This disease involves autoantibodies against desmoglein and desmocolinmolecules, being induced by the use of certain drugs. Mupirocin (pseudomonic acid A) is a broad-spectrum antibiotic withbacteriostatic activity, being effective against Gram-positive pathogens and used to control superficial bacterial folliculitis.Based on that, the aim of this study was to report a pemphigus-like lesions after topical use of mupirocin in dog.Case: An 1-year-old, uncastrated male, Poodle dog, weighing 13.8 kg was treated in a private clinic in Fortaleza. The maincomplaint was related to pruritus in abdominal and inguinal region, in addition of legs licking. Dermatological examination revealed melanic crusts, epidermal collars and diffuse pustules in inguinal, abdominal, perianal and thoraco-lumbarregions. The therapy was based on topical use of Mupirocin in form of 0.2% aquous spray. After drug administration, theanimal presented urticaria, diffuse epidermal collars, papulo-crusted and pustular lesions, which were more evident inabdominal and inguinal region. Nasal erythema, binocular blepharitis, apathy and fever were also observed. Cytologicalexamination and bacterial culture were performed, revealing inflammatory and acantholytic cells and no bacterial growth.Biopsy procedure revealed subcorneal pustule with presence of epithelial acantholytic cells and neutrophils, compatiblewith canine pemphigus foliaceous. The topical treatment of ocular lesions with 0.1% Tacrolimus associated with systemictreatment with high dose of prednisolone (1.2 mg kg-1)...
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Animais , Cães , Toxidermias/terapia , Toxidermias/veterinária , Mupirocina/efeitos adversos , Pênfigo/etiologia , Pênfigo/veterinária , Doenças Autoimunes/veterináriaRESUMO
As reações de hipersensibilidade a medicamentos são frequentes na prática clínica e são consideradas problema de saúde pública. O diagnóstico inclui, após detalhada história clínica, a realização de testes in vivo: cutâneos ou de provocação. Recentemente, estes testes foram aprovados pela Câmara Técnica da Associação Médica Brasileira para inclusão tanto no SUS, como na Saúde Suplementar, o que facilitará o acesso dos pacientes a estas ferramentas. Nesta revisão, abordaremos com mais detalhes as indicações, técnica e impacto da utilização dos testes cutâneos com fármacos na prática clínica.
Hypersensitivity drug reactions are frequent in clinical practice and are considered an important public health issue. Diagnosis includes a detailed clinical history, followed by in vivo tests, such as skin tests and drug provocation tests. Those tests were recently approved by the Brazilian Medical Association Technical Board to be included in both public and private practice, which will facilitate investigation with those tools. In this review paper, we will address in more detail the indications, technique, and impact of the use of skin tests to drugs in clinical practice.
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Humanos , Testes Cutâneos , Hipersensibilidade a Drogas , Hipersensibilidade a Drogas/prevenção & controle , Sociedades Médicas , Sistema Único de Saúde , Preparações Farmacêuticas , Prontuários Médicos , Diagnóstico , Habilidades para Realização de Testes , Hipersensibilidade , MétodosRESUMO
Drug hypersensitivity reactions (DHRs) represent growing health problem worldwide, affecting more than 7% of the general population, and represent an important public health problem. However, knowledge in DHRs morbidity and mortality epidemiological data is still not optimal and international comparable standards remain poorly accessed. Institutional databases worldwide increasingly use the WHO International Classification of Diseases (ICD) system to classify diagnoses, health services utilization, and death data. The misclassification of disorders in the ICD system contributes to a lack of ascertainment and recognition of their importance for healthcare planning and resource allocation. It also hampers clinical practice and prevention actions. To further inform the allergy community and to ensure that the revision process is transparent as advised in the WHO ICD-11 revision agenda, we report the advances and use of the pioneering "Drug hypersensitivity" subsection of ICD-11 and implementation in the WHO International Classification of Health Interventions (ICHI). The new classification addressed to DHRs will enable the collection of more accurate epidemiological data to support quality management of patients with drug allergies and better facilitate healthcare planning and decision-making and public health measures to prevent and reduce the morbidity and mortality attributable to DHRs.
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Hipersensibilidade a Drogas/classificação , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/terapia , Classificação Internacional de Doenças/normas , Humanos , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To assess the incidence of intra-operative immediate hypersensitivity reactions and anaphylaxis. METHODS: A cross-sectional observational study was conducted at the Department of Anesthesiology, University of São Paulo School of Medicine, Hospital das Clínicas, São Paulo, Brazil, from January to December 2010. We developed a specific questionnaire to be completed by anesthesiologists. This tool included questions about hypersensitivity reactions during anesthesia and provided treatments. We included patients with clinical signs compatible with immediate hypersensitivity reactions. Hhypersensitivity reactions were categorized according to severity (grades I-V). American Society of Anesthesiologists physical status classification (ASA 1-6) was analyzed and associated with the severity of hypersensitivity reactions. RESULTS: In 2010, 21,464 surgeries were performed under general anesthesia. Anesthesiologists answered questionnaires on 5,414 procedures (25.2%). Sixty cases of intra-operative hypersensitivity reactions were reported. The majority patients (45, 75%) had hypersensitivity reactions grade I reactions (incidence of 27.9:10,000). Fifteen patients (25%) had grade II, III or IV reactions (intra-operative anaphylaxis) (incidence of 7:10,000). No patients had grade V reactions. Thirty patients (50%) were classified as ASA 1. The frequency of cardiovascular shock was higher in patients classified as ASA 3 than in patients classified as ASA 1 or ASA 2. Epinephrine was administered in 20% of patients with grade III hypersensitivity reactions and in 50% of patients with grade II hypersensitivity reactions. CONCLUSIONS: The majority of patients had hypersensitivity reactions grade I reactions; however, the incidence of intra-operative anaphylaxis was higher than that previously reported in the literature. Patients with ASA 3 had more severe anaphylaxis; however, the use of epinephrine was not prescribed in all of these cases. Allergists and anesthesiologists should implement preventive measures to reduce the occurrence of anaphylaxis.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Inquéritos e Questionários/normas , Hipersensibilidade a Drogas/epidemiologia , Anafilaxia/epidemiologia , Complicações Intraoperatórias/epidemiologia , Anestesia Geral/efeitos adversos , Vasoconstritores/uso terapêutico , Índice de Gravidade de Doença , Brasil/epidemiologia , Epinefrina/uso terapêutico , Incidência , Estudos Transversais , Reprodutibilidade dos Testes , Fatores de Risco , Hipersensibilidade a Drogas/diagnóstico , Anestesiologistas/estatística & dados numéricos , Anafilaxia/diagnóstico , Complicações Intraoperatórias/diagnósticoRESUMO
The use of monoclonal antibodies (mAbs) has become broader because of their recognized effectiveness in the treatment of autoimmune, neoplastic, and inflammatory diseases. Consequently, hypersensitivity reactions (HSR) secondary to mAbs are being reported more often, and each mAb-related HSR presents specific features. This article discusses the main biological agents and associated HSR, the clinical presentation of such reactions, and the role of tryptase and skin testing in the diagnosis. Rapid drug desensitization procedures to mAbs enable selected allergic patients to receive full therapeutic doses in a safe manner and are also discussed.
Assuntos
Alérgenos/imunologia , Anticorpos Monoclonais/uso terapêutico , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/epidemiologia , Imunoterapia/métodos , Anticorpos Monoclonais/imunologia , Hipersensibilidade a Drogas/terapia , Humanos , Imunoglobulina E/metabolismo , Imunoterapia/efeitos adversos , Prevalência , Testes Cutâneos , Triptases/imunologiaRESUMO
Se exponen datos relacionados con la histología, fisiología y patología de los mastocitos, tanto normales como patológicos, y el papel de la alergia medicamentosa en la mastocitosis, así como las repercusiones psicopatológicas de la enfermedad y las bases neuroquímicas de dichos trastornos.
Data concerning the biological aspects of mastocytes, its pathology and the importance of childhood and adult mastocytosis are described. The role of drug allergy in mastocytosis is discussed. The psychopathological and neurochemical aspects of these conditions are exposed.