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A Skin Testing Strategy for Non-IgE-Mediated Reactions Associated With Vancomycin.
Lyu, Siyan; Oliver, Eric T; Dispenza, Melanie C; Chichester, Kristin L; Hoffman, Jennifer; MacGlashan, Donald W; Adkinson, N Franklin; Phillips, Elizabeth J; Alvarez-Arango, Santiago.
Afiliación
  • Lyu S; Johns Hopkins University, Baltimore, Md.
  • Oliver ET; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
  • Dispenza MC; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
  • Chichester KL; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
  • Hoffman J; Division of Clinical Pharmacology, Departments of Medicine and Pharmacology and Molecular Science, Johns Hopkins School of Medicine, Baltimore, Md.
  • MacGlashan DW; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
  • Adkinson NF; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md.
  • Phillips EJ; Center for Drug Safety and Immunology, Departments of Medicine, Dermatology, Pharmacology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn.
  • Alvarez-Arango S; Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Md; Division of Clinical Pharmacology, Departments of Medicine and Pharmacology and Molecular Science, Johns Hopkins School of Medicine, Baltimore, Md. Electronic address: salvarez@jhmi.
J Allergy Clin Immunol Pract ; 2024 Aug 06.
Article en En | MEDLINE | ID: mdl-39117269
ABSTRACT

BACKGROUND:

Vancomycin infusion reaction (VIR), reportedly mediated through Mas-Related G Protein-Coupled Receptor-X2, is the primary vancomycin-induced immediate drug reaction. Clinically, distinguishing the underlying drug-induced immediate drug reaction mechanisms is crucial for future treatment strategies, including drug restriction, re-administration, and pretreatment considerations. However, the lack of validated diagnostic tests makes this challenging, often leading to unnecessary drug restriction.

OBJECTIVE:

To determine whether intradermal tests (IDTs) and, separately, the basophil activation test (BAT) differentiate VIR from vancomycin-tolerant subjects.

METHODS:

This was a cross-sectional study of vancomycin-exposed adults with and without a history of VIR. Data on demographics, allergy-related comorbidities, history of vancomycin exposures, and VIR characteristics were collected. IDT with vancomycin was performed. IDT dose-response EC50, IDT-related local symptoms, and BAT results were compared between groups.

RESULTS:

A total of 11 VIR and 10 vancomycin-tolerant subjects were enrolled. The most reported VIR symptoms were pruritus (82%), flushing (82%), hives (46%), angioedema (27%), and dyspnea (19%). The IDT dose-response mean EC50 was 328 µg/mL (95% CI, 296-367) in the VIR versus 1166 µg/mL (95% CI, 1029-1379) in the tolerant group (P < .0001). All VIR subjects reported IDT-related local pruritus compared with 60% of tolerant subjects (P = .0185). The %CD63+ basophils were consistently less than 2%, without significant differences between groups (P < .54).

CONCLUSIONS:

Variations in skin test methodologies could help identify other immediate drug reaction mechanisms beyond IgE. This skin test protocol holds the potential for identifying VIR, particularly in cases where patients have received multiple drugs while BAT is insufficient. Future studies will validate and delineate its predictive value, assessing the risk of VIR.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Allergy Clin Immunol Pract Año: 2024 Tipo del documento: Article País de afiliación: Moldova Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: J Allergy Clin Immunol Pract Año: 2024 Tipo del documento: Article País de afiliación: Moldova Pais de publicación: Estados Unidos