RESUMO
OBJECTIVES: To estimate the risk of recurrence of adverse events following immunization (AEFIs) upon revaccination and to determine among patients with suspected vaccine allergy whether allergy skin test positivity was associated with AEFI recurrence. STUDY DESIGN: This prospective observational study included patients assessed in the Canadian Special Immunization Clinic Network from 2013 to 2019 with AEFIs who required revaccination with the vaccine temporally associated with their AEFI. Participants underwent standardized assessment and data collection. Special Immunization Clinic physicians used guidelines to inform their recommendations. Participants were followed up after revaccination to capture AEFI recurrences. Data were transferred to a central database for descriptive analysis. RESULTS: Overall, 588 participants were assessed for 627 AEFIs; 570 (91%) AEFIs occurred in children <18 years of age. AEFIs included immediate hypersensitivity (130/627; 21%), large local reactions (110/627; 18%), nonurticarial rash (51/627; 8%), seizures (26/627; 4%), and thrombocytopenia (11/627; 2%). Revaccination was recommended to 513 of 588 (87%) participants. Among participants recommended and due for revaccination during the study period, 63% (299/477) were revaccinated. AEFI recurrence was 10% (31/299) overall, 31% (15/49) for large local reactions, and 7% (5/66) for immediate hypersensitivity. No recurrence was serious. Among 92 participants with suspected vaccine allergy who underwent skin testing and were revaccinated, the negative predictive value of skin testing for AEFI recurrence was 96% (95% CI 92.5%-99.5%). CONCLUSIONS: Most individuals with AEFIs were safely revaccinated. Among those with suspected vaccine allergy, skin testing may help determine the safety of revaccination.
Assuntos
Hipersensibilidade Imediata , Hipersensibilidade , Imunização Secundária , Imunização , Vacinas , Criança , Humanos , Sistemas de Notificação de Reações Adversas a Medicamentos , Canadá , Hipersensibilidade/etiologia , Hipersensibilidade Imediata/induzido quimicamente , Imunização/efeitos adversos , Imunização Secundária/efeitos adversos , Vacinação/efeitos adversos , Vacinas/efeitos adversosRESUMO
BACKGROUND: Taxanes adjuvant therapy is recommended in certain high risk or metastatic tumors, particularly in lung and breast cancer, but also in other types of cancer like ovarian. The incidence of severe adverse drug reactions to paclitaxel is of approximately 10%. OBJECTIVES: Analyze type I hypersensitivity reactions to paclitaxel and their management in the Mexican population. METHOD: It is a retrospective, observational and descriptive study that included type I hypersensitivity reactions to paclitaxel reported from our database. Symptoms of hypersensitivity reactions to paclitaxel were classified and skin testing was performed with a 6 mg/mL paclitaxel concentration. The desensitization procedure consisted of a 12-steps, 3-bags of 250 mL protocol with a 6-7-hour duration. RESULTS: A total of 60 desensitization procedures were performed and were all completed successfully. All participants in our group were female, their median age was 44.5 years.All of our patients had hypersensitivity adverse drug reaction to paclitaxel during their first exposure and within the first 10 minutes of infusion. 63.6% of the patients had a moderate hypersensitivity reaction to paclitaxel and 36.4% had a severe reaction. CONCLUSIONS: Paclitaxel continues to be a common use drug and has a high rate of adverse drug reactions. This is the first study of hypersensitivity to paclitaxel in a Mexican population.
Assuntos
Neoplasias da Mama , Hipersensibilidade a Drogas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Hipersensibilidade Imediata , Adulto , Neoplasias da Mama/complicações , Dessensibilização Imunológica/métodos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Feminino , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/complicações , Masculino , Paclitaxel/efeitos adversos , Estudos RetrospectivosRESUMO
BACKGROUND: Cefazolin is routinely recommended as the first-line agent for surgical antibiotic prophylaxis because it prevents more surgical site infections than second-line antibiotics. Clinicians often avoid administering cefazolin to patients who are labeled as penicillin allergic due to concerns of cross-reactivity. The aim of this study was to compare the incidence of hypersensitivity reactions between cefazolin and the second-line antibiotics vancomycin and clindamycin. METHODS: This retrospective study included patients who were labeled as penicillin allergic and received either cefazolin, clindamycin, or vancomycin as preoperative antibiotics. The primary outcome was intraoperative hypersensitivity reactions. RESULTS: A total of 734 surgical procedures in 690 patients were included. Fifteen immediate hypersensitivity reactions were identified. Probable hypersensitivity reactions occurred in 3 (0.9%) patients in the cefazolin group, 4 (1.4%) in the clindamycin group, and 1 (1.1%) in the vancomycin group. Seven of 8 patients reported allergies to additional medications beyond penicillin. There were seven cases of possible hypersensitivity reactions, 3 (0.9%) in the cefazolin group, 1 (1.1%) in the vancomycin group, and 3 (1.0%) in the clindamycin group. CONCLUSION: Our data suggest that perioperative hypersensitivity reactions are uncommon in patients labeled as penicillin allergic. The frequency of immediate hypersensitivity reactions was not different between patients receiving cefazolin, clindamycin, or vancomycin. Avoiding cefazolin in patients labeled as penicillin allergic may not be warranted.
Assuntos
Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Cefazolina/efeitos adversos , Clindamicina/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Imediata/induzido quimicamente , Penicilinas/efeitos adversos , Vancomicina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Cefazolina/uso terapêutico , Clindamicina/uso terapêutico , Feminino , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/métodos , Vancomicina/uso terapêuticoRESUMO
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.
Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Imediata/induzido quimicamente , Cetoprofeno/efeitos adversos , Adulto , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/tratamento farmacológico , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/tratamento farmacológico , Cetoprofeno/administração & dosagem , Cetoprofeno/uso terapêutico , Masculino , Dor/tratamento farmacológico , Resultado do TratamentoRESUMO
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.
Assuntos
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: Reactions to beta-lactams are frequent and it is difficult to establish the relationship between the drug and symptoms. OBJECTIVE: To describe the clinical characteristics and explore the immunological mechanisms of patients with suspected adverse reaction to beta-lactams. METHODS: Retrospective study of patients with a history of beta-lactam reaction and tests for reactions to drugs. RESULTS: Out of 125 patients, 71 were women (56.8%); 73 had a history of immediate reaction and 52 delayed reaction; 590 allergy tests were done: specific IgE measurement, skin prick, patch, and provocation tests. The drugs most often related were amoxycillin, in 62 patients (49.6%), crystalline penicillin in 17 (13.6%), benzathine penicillin in 15 (12%), and cefalexin in 13 (10.4%). The severity of the reaction was mild in the majority (82%). 7.7% had a history of anaphylaxis and 10.8% sought care for a positive penicillin skin test, without history of reaction. Only 6.7% resulted in a positive test. More than 62% began testing two years after the reaction for which they sought care. CONCLUSIONS: The clinical history is insufficient to determine allergy to beta-lactams. In our sample, few patients with a history of beta-lactam reaction had evidence of immune-mediated reactions.
Antecedentes: Las reacciones a betalactámicos son frecuentes y es difícil establecer la relación entre el medicamento y los síntomas. Objetivo: Describir las características clínicas y explorar los mecanismos inmunológicos de pacientes con sospecha de reacción adversa a betalactámicos. Métodos: Estudio retrospectivo de pacientes con antecedentes de reacción a betalactámicos y pruebas para reacción con medicamentos. Resultados: De 125 pacientes, 71 eran mujeres (56.8%); 73 tenían historia de reacción inmediata y 52 de reacción tardía; Se realizaron 590 pruebas de alergia: medición de IgE específica, pruebas intradérmicas, de parche y de provocación. Los medicamentos más relacionados fueron amoxicilina, en 62 pacientes (49.6%), penicilina cristalina en 17 (13.6%), penicilina benzatínica en 15 (12%) y cefalexina en 13 (10.4%). La severidad de la reacción fue leve en la mayoría (82%). 7.7% tuvo antecedente de anafilaxia y 10.8% consultaba por una prueba cutánea con penicilina positiva, sin antecedente de reacción. Solo 6.7% resultó con una prueba positiva. Más de 62% inició los estudios dos años después de la reacción por la que consultó. Conclusiones: La historia clínica es insuficiente para determinar la alergia a betalactámicos. En nuestra muestra, pocos pacientes con antecedente de reacción a betalactámicos tuvo evidencia de reacciones inmunológicamente mediadas.
Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Imediata/induzido quimicamente , beta-Lactamas/efeitos adversos , Amoxicilina/efeitos adversos , Cefalexina/efeitos adversos , Feminino , Humanos , Masculino , Penicilinas/efeitos adversos , Estudos Retrospectivos , Testes CutâneosRESUMO
Corticosteroid hypersensitivity is a complex phenomenon in which many factors interact, such as idiosyncrasy, intolerance or allergic reactions. The prevalence of immediate hypersensitivity reactions to corticosteroids is 0.2%-0.5%. Corticosteroids have major therapeutic implications; thus, when hypersensitivity is suspected, in-vitro and/or in-vivo testing can be performed to confirm diagnosis, being the drug challenge the gold standard. After definitive diagnosis, cross-reactivity among the different corticosteroid groups should be considered, to choose wisely if corticosteroid therapy is still required. In Coopman classification, steroids belonging to groups A, B and D2 have high cross-reactivity, however, more studies are needed to determine the degree of cross-reaction among these drugs. This paper presents the case of a woman, in who hypersensitivity to hydrocortisone succinate was confirmed by drug challenge test.
La hipersensibilidad a corticoesteroides es un fenómeno complejo en el que interactúan múltiples factores como idiosincrasia, intolerancia o alergia. La prevalencia de las reacciones de hipersensibilidad inmediata a corticoesteroides es de 0.2 a 0.5%. Debido a la relevancia terapéutica de los esteroides, es importante confirmar el diagnóstico de hipersensibilidad con pruebas in vivo, in vitro, o ambas, el patrón de referencia es la prueba de reto con el fármaco implicado. Una vez realizado el diagnóstico y en caso de que se requiera continuar con el tratamiento con esteroides, deberá considerarse la reactividad cruzada entre los diferentes grupos propuestos en la clasificación de Coopman, en la que los corticoesteroides pertenecientes a los grupos A, B y D2 tienen una elevada reactividad cruzada entre sí; sin embargo, hacen falta más estudios para determinar el grado de reactividad cruzada entre estos fármacos. Comunicamos el caso de una paciente en la que se confirmó el diagnóstico de hipersensibilidad a succinato de hidrocortisona con la prueba de reto.
Assuntos
Hipersensibilidade a Drogas/diagnóstico , Hidrocortisona/análogos & derivados , Hipersensibilidade Imediata/diagnóstico , Administração Oral , Corticosteroides/química , Corticosteroides/classificação , Corticosteroides/imunologia , Corticosteroides/farmacocinética , Adulto , Anafilaxia/induzido quimicamente , Angioedema/induzido quimicamente , Reações Cruzadas , Relação Dose-Resposta a Droga , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/fisiopatologia , Feminino , Haptenos/imunologia , Humanos , Hidrocortisona/administração & dosagem , Hidrocortisona/efeitos adversos , Hidrocortisona/imunologia , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/fisiopatologia , Estrutura Molecular , Relação Estrutura-AtividadeRESUMO
Drug provocation tests (DPTs) are considered the gold standard for identifying adverse drug reactions (ADRs). The aim of this study was to analyze DPT results and discuss severe systemic reactions associated with them. This was a retrospective analysis of 500 patients with ADRs who sought treatment and were submitted to DPTs when indicated between 2006 and 2010. We performed DPTs according to the European Network for Drug Allergy recommendations. Single-blind, placebo-controlled DPTs were performed with antibiotics, local anesthetics, and nonsteroidal anti-inflammatory drugs, as well as with other drugs. Patient characteristics, DPT results, and reactions were analyzed. The sample comprised 198 patients (80.8% of whom were female patients) submitted to 243 DPTs. Ages ranged from 9 to 84 years (mean, 39.9 years). The 243 DPTs were performed with local anesthetics (n = 93), antibiotics (n = 19), acetaminophen (n = 44), benzydamine (n = 33), COX-2 inhibitors (n = 26), dipyrone (n = 7), aspirin (n = 4), or other drugs (n = 17). The results of 4 tests (1.6%) were inconclusive, whereas those of 10 (4.1%) revealed positive reactions to antibiotics (2/19), COX-2 inhibitors (2/26), acetaminophen (3/44), and local anesthetics (3/93). Two severe reactions were observed: cephalexin-induced anaphylactic shock and bupivacaine-induced anaphylaxis without shock. Four patients (2.0%) reacted to the placebo before administration of the drug. Drug provocation tests are safe for use in clinical practice but they should be placebo-controlled and should be performed under the supervision of an allergist. To confirm a presumptive diagnosis and to manage allergies appropriately, it is crucial to perform DPTs.
Assuntos
Anestésicos Locais , Antibacterianos , Anti-Inflamatórios não Esteroides , Hipersensibilidade a Drogas/diagnóstico , Preparações Farmacêuticas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anafilaxia/epidemiologia , Anestésicos Locais/administração & dosagem , Anestésicos Locais/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/efeitos adversos , Criança , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/epidemiologia , Masculino , Pessoa de Meia-Idade , Preparações Farmacêuticas/administração & dosagem , Estudos Retrospectivos , Método Simples-Cego , Testes Cutâneos/métodos , Adulto JovemRESUMO
OBJECTIVE: To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics. SOURCES: Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts. SUMMARY OF THE FINDINGS: Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10% of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs' four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95%) and minor determinants (5%). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95% of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. CONCLUSIONS: The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.
Assuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Imediata/induzido quimicamente , Penicilinas/efeitos adversos , Antibacterianos/química , Antibacterianos/imunologia , Cefalosporinas/química , Cefalosporinas/imunologia , Criança , Humanos , Penicilinas/química , Penicilinas/imunologia , Sensibilidade e Especificidade , Testes Cutâneos , Fatores de TempoRESUMO
OBJETIVO: Apresentar uma abordagem prática ao diagnóstico e conduta na alergia a antibióticos beta-lactâmicos. FONTES DOS DADOS: Periódicos da área de alergia indexados nas bases MEDLINE e LILACS, além de estudos e textos clássicos que tratam do tema. SíNTESE DOS DADOS: A alergia à penicilina é relatada com freqüência, em muitos casos resultando na exclusão desse medicamento do arsenal terapêutico. Cerca de 10 por cento dos relatos de alergia a drogas são confirmados. As manifestações clínicas decorrentes da reação alérgica à penicilina são bastante amplas, destacando-se os quadros cutâneos. Os quatro mecanismos de hipersensibilidade de Gell & Coombs estão envolvidos nas reações alérgicas. A penicilina é degradada em determinante maior (95 por cento dos produtos) e em determinantes menores (5 por cento dos produtos). As reações imediatas, mediadas por IgE, e que determinam quadros de anafilaxia, estão relacionadas aos determinantes menores em 95 por cento dos casos. A hipersensibilidade a esses produtos pode ser avaliada através de testes cutâneos realizados com os determinantes maior e menores, permitindo, assim, evitar o choque anafilático em indivíduos alérgicos. O texto ressalta conhecimentos básicos sobre a alergia à penicilina, propiciando um diagnóstico mais adequado desse evento e a conduta em casos de suspeita de alergia a beta-lactâmicos. CONCLUSÃO: O diagnóstico de alergia à penicilina tem sido feito de forma inadequada, resultando em sua exclusão do arsenal terapêutico. O melhor reconhecimento dessas condições permitirá o uso da penicilina com diminuição dos riscos decorrentes da hipersensibilidade.
OBJECTIVE: To present a practical approach to the diagnosis and management of allergy to beta-lactam antibiotics. SOURCES: Allergy journals indexed in MEDLINE and LILACS, as well as seminal studies and texts. SUMMARY OF THE FINDINGS: Allergy to penicillin is commonly reported. In many cases, this results in the decision not to use this drug. About 10 percent of drug allergy reports are confirmed. The clinical manifestations due to allergic reaction to penicillin vary widely, with emphasis on skin disorders. Gell & Coombs' four hypersensitivity mechanisms are involved in allergic reactions. Penicillin is degraded to a major (95 percent) and minor determinants (5 percent). Immediate IgE-mediated reactions causing anaphylaxis are associated with minor determinants in 95 percent of the cases. Hypersensitivity to these products can be assessed using cutaneous tests performed with major and minor determinants, thus avoiding anaphylactic shock in allergic individuals. The present article underscores the basic body of knowledge on allergy to penicillin, providing support for a more accurate diagnosis of this event and for the choice of management in cases of suspected beta-lactam allergy. CONCLUSIONS: The incorrect diagnosis of penicillin allergy frequently leads to the exclusion of this drug as a therapeutic option. A better recognition of these situations will enable the use of penicillin and reduce the risks associated with hypersensitivity.
Assuntos
Humanos , Criança , Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade Imediata/induzido quimicamente , Penicilinas/efeitos adversos , Antibacterianos/química , Antibacterianos/imunologia , Cefalosporinas/química , Cefalosporinas/imunologia , Penicilinas/química , Penicilinas/imunologia , Sensibilidade e Especificidade , Testes Cutâneos , Fatores de TempoRESUMO
BACKGROUND: There is some evidence suggesting a link between paracetamol exposure and atopy in both adults and children. OBJECTIVE: We aimed to investigate whether further epidemiological support for a link between paracetamol intake and allergy could be found in a population of Mexican children. METHODS: In a cross-sectional study design, we applied the ISAAC questionnaire to 3493 children aged 6 to 7 years old. Two analyses were performed: (1) children were classified as cases if they had wheezing, rhinitis, or eczema at any time from their neonatal period up until they reached the age of 6 to 7 years, or as controls if they had never experienced these conditions, and (2) children were classified as cases if they had wheezing, rhinitis, or eczema in the 12 months prior to the study. Paracetamol intake was considered positive if it frequently occurred during the first year of life (first analysis) or in the last 12 months (second analysis). RESULTS: Paracetamol intake in the first year of life was significantly associated with an increased risk of ev having wheezing (adjusted odds ratio [OR], 1.69; 95% confidence interval [CI], 1.23 to 2.34) and rhinitis (adjusted OR, 1.37; 95% CI, 1.20 to 1.59) but not eczema (adjusted OR, 1.45; 95% CI, 0.91 to 2.32). Frequent paracetamol intake in the last year increased the risk of wheezing (OR, 3.3; 95% CI, 1.54 to 7.18), rhinitis (OR, 1.61; 95% CI, 1.33 to 1.95), or eczema (OR, 1.82; 95% CI, 1.24 to 2.66). CONCLUSION: Frequent paracetamol exposure was associated with a significantly increased risk of wheezing and rhinitis and probably eczema in a Mexican population of children.
Assuntos
Acetaminofen/efeitos adversos , Dermatite Atópica/induzido quimicamente , Sons Respiratórios/etiologia , Rinite/induzido quimicamente , Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Analgésicos não Narcóticos/efeitos adversos , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Estudos de Casos e Controles , Criança , Pré-Escolar , Dermatite Atópica/etiologia , Dermatite Atópica/metabolismo , Feminino , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/etiologia , Hipersensibilidade Imediata/metabolismo , Lactente , Recém-Nascido , Masculino , México , Estresse Oxidativo/efeitos dos fármacos , Rinite/etiologia , Rinite/metabolismo , Fatores de Risco , Inquéritos e QuestionáriosRESUMO
Hevein (Hev b 6.02) is a major IgE-binding allergen in natural rubber latex and manufactured products. Both tryptophans (Trp(21) and Trp(23)) of the hevein molecule were chemically modified with BNPS-skatole (2-nitrophenylsulfenyl-3-methyl-3(')-bromoindolenine); derivatized allergen failed to significantly inhibit binding of serum IgE in ELISA assays. Similarly, skin prick tests showed that hevein-positive patients gave no response with the modified allergen. Dot blot experiments carried out with anti-hevein mono- and polyclonal antibodies confirmed the importance of Trp(21) and Trp(23) for antibody-recognition, and demonstrated the specific cross-reactivity of other molecules containing hevein-like domains. We also report the structure of Hev b 6.02 at an extended resolution (1.5A) and compare its surface properties around Trp residues with those of similar regions in other allergens. Overall our results indicate that the central part of the protein, which comprises three aromatic and other acidic and polar residues, constitutes a conformational epitope.
Assuntos
Peptídeos Catiônicos Antimicrobianos , Mapeamento de Epitopos/métodos , Epitopos/química , Imunoglobulina E/química , Hipersensibilidade ao Látex/induzido quimicamente , Modelos Moleculares , Lectinas de Plantas/química , Triptofano/química , Alérgenos/química , Alérgenos/imunologia , Alérgenos/toxicidade , Sequência de Aminoácidos , Criança , Pré-Escolar , Simulação por Computador , Cristalografia por Raios X , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/imunologia , Imunoglobulina E/imunologia , Lactente , Recém-Nascido , Hipersensibilidade ao Látex/imunologia , Dados de Sequência Molecular , Lectinas de Plantas/imunologia , Lectinas de Plantas/toxicidade , Conformação Proteica , Testes Cutâneos , Relação Estrutura-AtividadeRESUMO
OBJECTIVE: To evaluate the incidence of adverse reactions to first and second bacille Calmette-Guérin (BCG) vaccination in schoolchildren. SETTING AND DESIGN: Enhanced surveillance in a Brazilian trial. Suspected reactions were reported to a nurse who visited cases and completed a standard form. RESULTS: Among 71341 schoolchildren studied, 33 reactions were reported. Of these, 25 fulfilled the criteria, resulting in a rate of one per 2854 vaccinations, with no deaths or BCG-osis. Reactions to second doses were more common than to first BCG vaccinations, but this difference was not statistically significant. CONCLUSIONS: Adverse reactions to a second dose of BCG may be more frequent than reactions to a first dose, but they are still rare events.
Assuntos
Vacina BCG/efeitos adversos , Vacinação em Massa/efeitos adversos , Tuberculose Pulmonar/prevenção & controle , Adolescente , Vacina BCG/administração & dosagem , Brasil/epidemiologia , Criança , Estudos de Coortes , Relação Dose-Resposta a Droga , Eritema/induzido quimicamente , Eritema/epidemiologia , Feminino , Febre/induzido quimicamente , Febre/epidemiologia , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/epidemiologia , Esquemas de Imunização , Linfadenite/induzido quimicamente , Linfadenite/epidemiologia , Masculino , Prevalência , Prognóstico , Sistema de Registros , Medição de Risco , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/epidemiologia , EstudantesRESUMO
OBJECTIVES: Cow's milk protein-sensitive enteropathy (CMSE) may persist in children to school age. We sought to define the morphologic and immunohistochemical features of persistent CMSE. STUDY DESIGN: We studied 15 children with a definite diagnosis of CMSE on the basis of a blind challenge, 12 children with suspected cases of CMSE, 11 children with celiac disease, and 12 control children. RESULTS: Typical findings in children with CMSE were endoscopically visible lymphonodular hyperplasia of the duodenal bulb and lymphoid follicles without villous atrophy in biopsy samples. The patients with definite CMSE showed significantly increased densities of intraepithelial T cells skewed clearly to gammadelta(+) cells, compared with the control patients but fewer than in the patients with celiac disease. The study children showed no aberrant upregulation of HLA-DR expression in the duodenal mucosa, and the prevalence of HLA DQ2 antigen among them was equal to that in the control children. CONCLUSIONS: Our observations corroborated the claim that CMSE at school age is an identifiable clinical entity. Immunohistochemical findings suggest the abrogation of antigen tolerance locally on the gastrointestinal mucosa. A careful clinical assessment that includes a long elimination-challenge test supported by typical endoscopic and histologic findings form the basis for diagnosis.
Assuntos
Enteropatias/induzido quimicamente , Enteropatias/imunologia , Hipersensibilidade a Leite/imunologia , Hipersensibilidade a Leite/patologia , Proteínas do Leite/efeitos adversos , Proteínas do Leite/imunologia , Adolescente , Fatores Etários , Doença Celíaca/patologia , Criança , Desenvolvimento Infantil , Sistema Digestório/imunologia , Sistema Digestório/patologia , Endoscopia Gastrointestinal , Feminino , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/imunologia , Hipersensibilidade Imediata/patologia , Enteropatias/patologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/patologia , Masculino , Linfócitos T/imunologia , Linfócitos T/patologiaRESUMO
The role of isolated components obtained by gel filtration chromatography of Ascaris suum body extract (Asc) on the modulation of the immune response to ovalbumin (OvA) was evaluated and correlated with the immunogenic properties of such components. We showed that high (PI), but not low (PIII), molecular weight components have the ability to inhibit OvA-induced immediate and DTH reactions, lymph node (LN) cell proliferation, cytokine (IL-2, interferon-gamma (IFN-gamma), IL-4 and IL-10) and antibody (IgG1, IgG2a, IgM and IgE) production in mice concomitantly immunized with OvA and these high mol. wt components. The pattern of cytokines synthesized in response to PI or PIII was totally different: the former induced more IL-4 and IL-10 and the latter more IL-2 and IFN-gamma. The levels of Asc-specific IgG1 antibodies were higher in mice immunized with OvA plus PI and IgG2a anti-Asc antibodies predominated in those immunized with PIII. IgE antibody production, however, was low in the former group of mice. These results indicate that the high mol. wt components present in the body extract from the helminth A. suum are responsible for its suppressive effect upon Th1- and Th2-dependent immune responses to an unrelated antigen. The suppression of the Th1-dependent parameters could be related to high-level expression of IL-4 and IL-10 induced by such components.
Assuntos
Antígenos de Helmintos/imunologia , Ascaris suum/imunologia , Tolerância Imunológica , Animais , Antígenos de Helmintos/química , Divisão Celular , Fracionamento Celular , Citocinas/metabolismo , Hipersensibilidade Tardia/induzido quimicamente , Hipersensibilidade Tardia/imunologia , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/imunologia , Isotipos de Imunoglobulinas/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos DBA , Peso Molecular , Ovalbumina/imunologia , Ovalbumina/farmacologiaRESUMO
178 439 cases of patients exposed to iodinated contrast media (ICM) corresponding to 137 147 to patients for excretory urography and 41 292 to cholangiography were studied. A direct interrogation making emphasis on personal antecedents of allergy to contrast media, iodinated products usage, nervous system and cardiovascular illnesses was made. Cutaneous test for iodinated contrast media was applied. If the result was positive no study with the ICM was made or it was made with special guidelines. 4302 positives and 1276 false negatives were found. 287 positive cases were premeditated and preventive medication was administered in cases of urticaria asthma/and angioedema with negative cutaneous test histories. There were no deaths registered.
Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade Imediata/epidemiologia , Iodo/efeitos adversos , Colangiografia , Humanos , Hipersensibilidade Imediata/induzido quimicamente , México/epidemiologiaRESUMO
Durante 29 años se estudiaron 178, 439 casos de pacientes expuestos a medios de contraste yodado (MCY) correspondiendo 137,147 a pacientes para urografía excretora y 41,292 a colangiografía. Se realizó un interrogatorio directo insistiendo en los antecedentes personales de alergia a medios de contraste, uso de productos yodados, enfermedades del sistema nervioso y cardiovascular. Se aplicó la prueba cutánea de medios de contraste yodado. Si el resultado fue positivo no se efectuó estudio alguno con medios de contraste yodado o se hizo con medidas especiales. Se encontraron medicamentos preventivos cuando hubo antecedentes de urticaria, asma o angioedema con prueba cutánea negativa. No se registraron casos de muerte
Assuntos
Humanos , Colangiografia , Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade Imediata/induzido quimicamente , Hipersensibilidade Imediata/epidemiologia , Iodo , Iodo/efeitos adversos , Urografia , México/epidemiologiaRESUMO
Objectivo: Avaliar a prevalência de sensibilizaçao a aeroalérgenos em estudantes de graduaçao em Medicina. Métodos: Foram selecionados 21 internos do Hospital de Clínicas da UNICAMP - Campinas/SP. Os indivíduos compreenderam dois grupos distintos, sendo o Grupo Controle (GC) formado por nove alunos sem história familiar ou pessoal de atopia e a Grupo Estudado (GE) formado por 12 alunos atópicos com rinite alérgica e/ou asma brônquica. Os dois grupos foram submetidos a teste cutâneo de sensibilidade imediata por puntura (PT) e à dosagem de IgE sérica específica para os aeroalérgenos pela técnica do RAST (Radioallergosorbent test). Resultados: Os resultados demonstraram uma incidência de positividade significativamente aumentada no GE para o extrato de poeira domiciliar (PT) com p<0,03) e para o ácaro Dermatophagoides pteronyssinus (RAST com p<0,03). Quando comparados a estudos anteriores com pacientes atópicos da regiao de Campinas-SP, observou-se menor sensibilizaçao ao ácaro de estocagem Blomia tropicalis, tanto para resultados obtidos com o PT (p<0,01), como com o RAST (p<0,05). Conclusoes: Nossos resultados demonstram sensibilizaçao diferenciada da populaçao de atópicos da regiao de Campinas - SP.
Assuntos
Humanos , Masculino , Feminino , Adulto , Alérgenos/efeitos adversos , Hipersensibilidade a Drogas , Hipersensibilidade Imediata/induzido quimicamente , Distribuição de Qui-Quadrado , Hipersensibilidade Imediata , Prevalência , Testes Cutâneos , Estudantes de MedicinaRESUMO
Las reacciones alérgicas abarcan manifestaciones clínicas variadas, que pueden ir de leve (como la que describiremos en este artículo), reacciones retardadas que pueden ocurrir hasta 48 horas después de la exposición al alergeno; hasta las reacciones inmediatas de hipersensibilidad - anafilaxis, las cuales se desarrollan en segundos y ponen en peligro la vida del paciente. Aunque el angioedema es una ocurrencia poco común en el consultorio dental, puede convertirse en una situación embarazosa para el odontólogo. El artículo tiene por finalidad presentar un caso clínico de angioedema neurótico de labio superior, su manejo y los aspectos que deben ser considerados para evitar dichas reacciones. Igualmente, el artículo pretende motivar a los odontólogos a reforzar los conocimientos en el manejo de urgencias médicas
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Angioedema/diagnóstico , Reações Antígeno-Anticorpo , Hipersensibilidade Imediata/induzido quimicamente , Corticosteroides/uso terapêutico , Queilite/terapia , Antagonistas dos Receptores Histamínicos H1/uso terapêutico , Cimento de Óxido de Zinco e Eugenol/efeitos adversosRESUMO
The inhalation of different substances of plant origin can cause immediate and late onset asthma. The list of these agents responsible for such reactions is continuously increasing. We discuss a patient who developed symptoms of asthma after exposure to Pfaffia paniculata root powder used in the manufacturing of Brazil ginseng capsules. Airway hyperreactivity was confirmed by a positive bronchial challenge to methacholine. Sensitivity to this dust was confirmed by immediate skin test reactivity, a positive bronchial challenge (immediate response), and the presence of specific IgE detected by ELISA technique to an aqueous extract. The bronchial response was inhibited by sodium cromoglycate. Unexposed subjects did not exhibit reactivity to this ginseng extract with any of the tests referred to above. The same study performed with Korean ginseng (Panax ginseng) elicited negative results. This study is the first, to our knowledge, that links ginseng-root dust to occupational asthma.