The pattern of adverse effects related to antimicrobial therapy in a tertiary care hospital

Background: Antimicrobial drugs are life-saving drugs but they come with their own share of adverse drug reactions (ADRs). Institutional drug policy helps in the rational use of the antimicrobial for the given clinical condition. This helps in controlling the development of resistance as well as minimizing adverse events. Aims and Objectives: This study aims to share the pattern of adverse reactions seen to the commonly prescribed antimicrobials. Materials and Methods: This is a retrospective, observational study. The data of patients, admitted to a tertiary care center in North Kerala who reported adverse effects related to antimicrobial treatment, were obtained from the case files from the medical record library. ADRs with antimicrobials reported during the period from November 2018 to November 2019 were obtained and the data were expressed as percentages in Microsoft excel. Causality assessment was done using the world health organization casualty scale. Results: 92 case reports were analyzed. Among the different antimicrobials used, Ciprofloxacin was the most commonly prescribed antimicrobial (18.5%) followed by ceftriaxone (12%). 13 different patterns of ADRs were obtained following the use of these drugs, among which allergic reactions to drugs were the most common (71.7%) with a causality assessment showing it to be the probable cause. Conclusion: The monitoring of ADRs to antimicrobials is the need of the hour. This study helped in determining the different patterns of ADRs with antimicrobials. Active surveillance and complete reporting help in identifying these and reporting and managing them to prevent such occurrences in the future.

Factors Related to Real-world Suspected Allergic Reaction of Elememe Emulsion Injection / 中国实验方剂学杂志

ObjectiveTo analyze factors related to the suspected allergic reaction of elememe emulsion injection based on hospital information system. MethodData on cases that used elememe emulsion injection were collected from the information systems of 60 first-class hospitals nationwide. The nested case-control design method was adopted. Finally， 30 cases were included in the suspected allergy group and 120 cases in the control group. SAS 9.3 was employed for descriptive analysis of the gender， age， occupation， admission route， conditions of patients at the admission， and the diagnosis with frequency and percentage. The factors affecting the occurrence of suspected allergic reaction were analyzed by conventional logistic regression and propensity score weighted logistic regression. In the case that the number of independent variables was larger than the sample number， MCP （minimax concave penalty） was used to screen the key variables and the conditions of patients at admission， conditions of patients during hospitalization， hospital stay， diagnostic information， and medication information were compared between two groups. ResultThe male-to-female ratio was about 2∶1 in both groups and most of the patients were 46-65 years old. Patients in the control group were mainly "professional and technical personnel"， and the majority in the suspected allergy group were "business and service personnel" and "clerks and related personnel". They were mainly admitted at the outpatient and conditions of patients were average at the admission. Compared with the control group， suspected allergy group showed severe conditions during the hospitalization， short average hospital stay， large proportion with intravenous infusion， and low cure rate and effective rate. The results of logistic regression analysis showed no statistical difference in conditions of patients at admission， hospital stay， combined diseases， medicine dosage， and treatment course. ConclusionThe suspected allergic reaction of elememe emulsion injection mainly occurs in the first administration with rapid onset even with the dose lower than the commonly used one. The occurrence is related to the intravenous infusion and the severe conditions of patients during hospitalization and has nothing to do with the conditions of patients at admission， hospital stay， treatment course， use of other medicines， and diagnostic information. In summary， it is mainly related to the constitution and immune status of patients.

Ineffectiveness of Skin Tests in Predicting Allergic Reactions Induced by Chinese Herbal Injections / 中国结合医学杂志

OBJECTIVE@#To evaluate whether skin tests are suitable to predict the allergy reactions induced by Chinese herbal injections (CHIs).@*METHODS@#The skin tests including skin prick tests (SPT), intradermal tests (IDT) and provocation tests including subcutaneous tests and intravenous tests were administered to 249 healthy subjects and 180 allergic patients for 3 CHIs, including ginkgolide injection, diterpene ginkgolide meglumine injection and Salvianolate lyophilized injection. The results of the provocation tests were used as the "gold standard" to determine the sensitivity and specificity of the skin tests.@*RESULTS@#The results did not show any significant differences between the healthy and allergy groups in both skin tests and provocation tests (P>0.05). The specificities of SPT and IDT were 0.976 and 0.797, respectively, and the sensitivities of both SPT and IDT were 0.@*CONCLUSION@#Skin tests are insufficient to predict the likelihood of allergic reactions resulting from CHIs. (ChiCTR-CPC-15006921).

ETV in tuberculous meningitis with hydrocephalus and allergic reaction to VP shunt: a case report

Hydrocephalus is one of the most common complications of tuberculous meningitis (TBM) occurring in up to 85% of patients with the disease. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus in tuberculous meningitis (TBM). Although allergic reactions to the silicone in shunt device are very rare, the authors describe a case of silicone allergy causing multiple VP shunt revisions. Alternative choice is endoscopic third ventriculostomy (ETV), but it is debatable. ETV has variable success in these patients and is generally not advisable in patients in the acute stages of the disease. A 19-year-old woman with hydrocephalus in tuberculous meningitis, who had undergone multiple VP shunt revisions, presented with shunt malfunction caused by allergic reaction of the tissue surrounding the shunt tubing. Laboratory examination demonstrated high level IgE, high level ESR, and PCR-TBC Positive, related to the allergic reaction. Patient with ETV success score of 50. Patients received ETV and release VSS Shunt. ETV has success in these patients. VP Shunts complications remain a difficult problem in neurosurgical clinical practice. The most typical complications are mechanical obstruction and infection. Allergy to the silicone shunt tubing is quite rare. Silicone allergy is an even more rare occurrence because of its high biocompatibility and low biological reactivity. It is a challenge for ETV when TBM has difficulty to recognize anatomical landmarks on this patient. It could also consider in patients who have shunt failure, and might be a better option than shunt revision.

Risk Factors for Adverse Events of Therapeutic Plasma Exchange Assessed in a Single Center Study / 대한수혈학회지

BACKGROUND: Therapeutic plasma exchange (TPE) is used to remove pathologic substances involved in various disease etiologies. The use of TPE is increasing steadily in a variety of disease. This study analyzed the incidence, type and severity of adverse events (AE) according to the initial TPE of each patient in a single center. The risk factors for AE of TPE were also elucidated. METHODS: The medical and laboratory records of patients, who received TPE from January 2014 to December 2018, were reviewed retrospectively. The signs or symptoms during and after TPE were analyzed. RESULTS: TPE sessions were performed on 95 patients. The mean age was 53.3 years and men comprised 63.2%. The most common indication for TPE was desensitization for ABO-incompatible liver transplantation (ABO-i LT) (N=56, 58.9%). A total of 27 patients (28.4%) experienced AE during the initial TPE. The types of AE were allergic reactions (N=14, 14.7%), anaphylactic reaction (N=3, 11.1%), hypotension (N=5, 5.3%), hypocalcemic reaction (N=4, 4.2%), and febrile nonhemolytic reaction (N=1, 1.1%). The severities of AE were evaluated as mild in eight procedures (8.4 %), moderate in seventeen (17.9 %), and severe in two (2.1 %). Multivariable logistic regression analysis showed that the desensitization for ABO-i LT (odds ratio (OR), 2.08; 95% CI, 1.03~4.22) and the amount of FFP (OR, 1.07; 95% CI, 1.01~1.09) were associated with a higher incidence of AE. CONCLUSION: TPE can be performed under careful patient monitoring to provide prompt intervention, particularly in patients with desensitization of ABO-i LT using FFP.

Preclinical study on adverse reactions of Xingnaojing injection / 中国中药杂志

In this study, different batches of Xingnaojing injection products were first selected for pseudoallergic mice test, and the results showed that after injection of 6.6-fold clinical dose Xingnaojing injection, the mice showed a slight pseudoallergic reaction, while other mice injected with other batches of injections showed no obvious pseudoallergic reaction. Therefore, it is preliminarily believed that this mice model can effectively indicate the risk of pseudoallergic reactions in the clinical application of Xingnaojing injections. In addition, by changing some of the processes, a high concentration of Xingnaojing injection was prepared for mice pseudoallergic test and guinea pig systemic allergy test. The results showed no significant type Ⅰ allergic reaction in guinea pigs. Mild pseudoallergic reactions occurred in mice after a 6.6-fold clinical dose injection. Therefore, it is considered that for sensitive or idiosyncratic people, the concentration of certain chemical components in Xingnaojing injection will increase after entering the body, which may increase the risk of pseudoallergic reaction. However, due to the limitations of test models, the risk of Xingnaojing injection to induce allergic reactions cannot be ruled out. Finally, by increasing the content of borneol and Tween and (or) sodium chloride in Xingnnaojing Injection and testing its pseudoallergic reactions, the results showed that the combination of these three ingredients may produce new trace sensitization substance and induce pseudoallergic reactions.

Practice of Clinical Pharmacists Participating in One Case of Allergic Reactions Induced by Oxaliplatin / 中国药师

According to the mechanism , reasons, clinical characteristics and treatment principle of oxaliplatin-induced allergic re-actions ( DHRs) and combined with the specific situation of the patient , clinical pharmacists provided suggestions for the reuse of oxali-platin in one case of DHRs patient .The causes of allergic reactions were confirmed through the analysis , and the comprehensive drug prevention and pretreatment and pharmaceutical care were provided for doctors resulting in successful completion of oxaliplatin chemo -therapy without drug withdrawal .

Adverse reaction and screening of sensitizing substance of Shuxuening injection / 中国中药杂志

In this study, by the means of the active systemic allergy test in guinea pigs, passive skin allergy test in rats and pseudoallergic test in mice, it was determined that the "allergic reaction" of Shuxuening injection(SXNI) may not be a true IgE-mediated allergic reactions, but mainly of pseudoallergic reaction. Further pseudoallergic test proved that the pseudoallergic reactions of SXNI had difference between batches and showed dose dependence, so it was recommended to establish SXNI pseudoallergic reaction detection method for timely detecting and controlling the product risk of each batch products. In addition, as the pseudoallergic reactions of SXNI were dose-dependent, the dose and concentration of SXNI should be strictly controlled in clinical use. Then the main pseudoallergenic reaction test was conducted for the main monomer components in SXNI and the different fractions of Ginkgo biloba extract in mice, and the results showed that the sensitizing substances may mainly exist in YXY-3 fractions containing flavonol glycosides. By further chemically separating YXY-3, we got four chemical components. Among these four components, YXY-3-1 and YXY-3-2 were testified as the main allergenic components in SXNI through pseudoallergic test in mice. To make sure the specific chemical constituent that is responsible for the pseudoallergic reaction, in-depth study in follow-up experiments should be needed.

Allergenicity evaluation of reduning injection and intermediate using the mouse spleen cell proliferation assay / 中国药学杂志

OBJECTIVE: To evaluate the allergenicity of Reduning injection and intermediate using ultrafiltration and the mouse spleen cell proliferation assay. METHODS: The samples obtained by 3 kd ultra-filtration, were incubated with mouse spleen mononuclear cells for 3 d, and then the trypan blue staining was used to count the alive cells for the evaluation ol drug allergenicity. RESULTS: Effect of No. 1 of Reduning intermediate was strongest to stimulate proliferation of mononuclear cells, and then actions of No. 2-5 decreased in turn, after the refining processing. CONCLUSION: A four-step refining process reduces the stimulated actions of Reduning intermediates on the mononuclear cell proliferation. Most Reduning injection have no this action, but several batches ol samples with known clinical allergic reaction have the stimulated actions on the mononuclear cell proliferation. Ultrafiltration-mononuclear cell proliferation assay could be used for the determination of macromoleeular substances from Reduning injection.

Effect of Traditional Chinese Medicine Injections on Allergic Reactions / 世界科学技术-中医药现代化

This study was aimed to investigate allergic reactions of traditional Chinese medicine (TCM) injections, and to determine contents of serum IgE in sensitized animals. The correlation between preceding contents in serum and allergic reactions may be found, in order to offer experimental evidences for advancing the accuracy of anticipa-tion by allergic reactions. Passive cutaneous anaphylaxis (PCA) tests and anaphylactoid reactions were used in a vari-ety of TCM injections. ELISA method was used to determine the content of total serum IgE in sensitized animals. The PCA results of SHL, QKL, YXC, XST, GGS and CHN were negative. The PCA result of CWJ was positive. There was no significant difference for total serum IgE level between the experimental group and the normal saline group in the group of SHL, QKL, YXC, XST, GGS, CHN and CWJ. All TCM injections caused anaphylactoid symp-toms in guinea pigs. It was concluded that all TCM injections can cause allergic reactions in guinea pig. And the al-lergic reactions of TCM injections were not correlated with serum total IgE.

Chlorhexidine allergy due to topical application.

Chlorhexidine is commonly used in dentistry in various forms. Allergic reactions to chlorhexidine of both immediate and delayed type have been reported. Although the incidence is low there may be severe manifestations in some patients. This report presents a case of allergy to chlorhexidine following topical application.

Contribution of serum IL-4 and IgE to the early prediction of horse serum allergies in guinea pigs

BACKGROUND: Horse serum (HS) was a strong allergen for xenogeneic animals. However, the methods of test for allergen didn't authorized in Pharmacopeia of the United States, European Pharmacopeia, Japanese Pharmacopeia and British Pharmacopeia. Thus, new methods of test for allergen are required to control drug allergy. OBJECTIVE: To propose a new method for detecting horse serum induced allergic reactions of guinea pigs earlier. METHODS: Guinea pigs were sensitized successively by injecting different concentration of HS intravenously once a day for three times, serum level of IL-4 and total IgE were detected by method of enzyme linked immunosorbent assay (ELISA) before guinea pigs were challenged by injecting HS intravenously only once, and the results were compared with routine method of sensitization by injecting HS intraperitoneally every other day for three times. RESULTS: Serum level of IL-4 and total IgE increased significantly before guinea pigs were challenged, either in day 8 after intravenous sensitization (10%HS, 0.5 mL) or in day 14 and day 21 after intraperitoneal sensitization (10%HS, 0.5 mL), and allergic reactions occurred in all guinea pigs after challenged by injecting HS (10%, 1.0 mL) only once. CONCLUSION: It provides a new way to predict whether HS or other drugs can provoke allergic reactions earlier by detecting the serum level of IL-4 and total IgE in d8 after intravenous sensitization, this has a good application value in drug emergency test.

Evaluation of anti-allergic activity of gossypin and suramin in mast cell-mediated allergy model.

The mast cell-mediated allergic reactions are involved in many allergic diseases, such as asthma, allergic rhinitis and sinusitis. Stimulation of mast cells initiates the process of degranulation, resulting in the release of mediators such as histamine and an array of inflammatory cytokines. In this report, we investigated the effect of gossypin (a biflavonoid) and suramin (a synthetic polysulphonated naphtylurea) on the mast cell-mediated allergy model, and studied the possible mechanism of their action. Both gossypin and suramin inhibited (P<0.001) compound 48/80-induced systemic anaphylaxis reactions, antiprurities (P<0.001) and reduced the histamine release in rats. Further, both showed significant (P<0.001) protection against rat peritoneal mast cells activated by compound 48/80. Thus, our findings provide evidence that gossypin and suramin inhibit mast cell-derived allergic reactions.

Conocimientos y prácticas sobre Hylesia metabus (Cramer, 1775) y lepidopterismo en Capure, estado Delta Amacuro, Venezuela (Julio-Agosto 2005) / Knowledge and practices about Hylesia metabus (Cramer, 1775) and lepidopterism in Capure, Delta Amacuro state – Venezuela (July-August 2005)

La mariposa Hylesia metabus posee escamas o pelos urticantes que causan dermatitis y reacciones alérgicas conocidas como lepidopterismo, y en ocasiones representa un grave problema social y de salud pública. Desde septiembre 2004, la comunidad de Capure ha sido afectada por invasiones cíclicas de H. metabus y para implementar actividades de prevención y control, se requiere entender el contexto sociocultural de la población. El presente estudio descriptivo, exploratorio y de campo, buscó caracterizar conocimientos y prácticas sobre H. metabus y lepidopterismo en Capure, mediante la aplicación de encuestas a 45 personas mayores de 10 años de edad (41 criollos y 4 indígenas warao) y la observación directa. El 88,8% (n=40) de los encuestados describió el ciclo biológico de la mariposa, así como conocimientos adecuados sobre su comportamiento; 64,4% (n=29) nombró a H. metabus como “mariposa peluda” y los warao la identificaron como “warowaro tijia” (mariposa que pica); 85,0% (n=38) indicó que la comunidad puede participar en actividades de control y describió alternativas de participación. La prevalencia de lepidopterismo fue de 69,4% y los encuestados identifican su sintomatología con cuadros alérgicos y dermatológicos. Las prácticas realizadas ante el lepidopterismo fueron: 57,7% (n=26) tratamientos caseros, 20,0% tratamientos mixto y 11,1% asiste al ambulatorio. Los tratamientos caseros fueron de uso tópico, 44,7% (n=17) vinagre, 15,7% (n=6) desodorante de bolita y 10,5% (n=4) gasoil. La comunidad de Capure posee conocimientos adecuados sobre la H. metabus y aplica medidas de prevención ante el lepidopterismo. Es necesario articular un Programa permanente de Vigilancia y Control del Lepidopterismo y la mariposa Hylesia sp., con enfoque local y con participación comunitaria.

The Hylesia metabus butterfly has scales and urticant hairs that cause dermatitis and allergic reactions known as lepidopterism, and on occasions it represents a severe social and public health problem. Since September 2004, Capure has been affected by cyclical invading of H. metabus, and to implement activities for prevention and control, an understanding about socio-cultural context of the population is required. This descriptive, exploratory and camp study tried to characterize knowledges and practices about H. metabus and lepidopterism in Capure, by the application of surveys to forty five (45) persons older than ten years old (41 creole people and 4 indigenous Warao people) and direct observation. About 88.8% (n=40) of those polled, described the butterfly’s biological cycle, with adequate knowledge about its behavior; 64.4% (n=29) named H. metabus as “furry butterfly“, and the indigenous Warao identified it as “warowaro tijia” (butterfly that bites); 85% (n=38), indicated that the community can participate in control activities and described alternatives of participation. The prevelance of lepidopterism was 69.4% and those polled identified their symptoms as allergic reactions and dermatitis. The practices realized in lepidopterism were 57.7% (n=26) domestic treatments, 20.0% mixed treatments and 11.1% went to the hospital. The domestic treatments were topical uses, 44.7% (n=17) of vinegar, 15.7% (η=6) roll-on deodorant and 10.5% (n=4) gasoil. The Capure community has adequate knowledge about H. metabus disease and knows how to apply preventive control for lepidopterism. It is necessary to articulate a permanent surveillance and

Allergic reactions after intravenous injection of methylprednisolone: A case report / 대한마취과학회지

Corticosteroid preparations have anti-inflammatory and immunosuppressive properties and are used widely for the treatment of allergic disorders and asthma. Steroids themselves, however, can induce hypersensitivity reactions. In this study, we report the case of a 66-year-old man with chronic obstructive pulmonary disease who exhibited an allergic reaction (rash, bronchospasm, bradycardia, severe hypotension and cardiac arrest) immediately after the intravenous injection of methylprednisolone sodium succinate. Despite cardiopulmonary resuscitation, sinus rhythm was not restored. The anesthesiologist should be aware that allergic reactions to corticosteroids can occur.

Study on allergy to medications in staff of Bach Mai Hospital

Allergic reactions to medications are increasing not only in patients but also in medical practitioner. Objectives: 1) Finding out prevalence of drug allergy in Bach Mai hospital staffs and listed medications caused allergic reactions. 2) Comparison some aspects of drug allergy between the health staffs and other groups. 3, Study on clinical symptoms of drug allergy and bring forward views. Subjects: 215 physicians, pharmacists, nurses, techniciants of Bach Mai Hospital and 200 staffs with other jobs. Method: Cross-sectional comparative surveys. Results: The prevalence of allergic reaction in health staffs is higher and these ones had more likely to have drug allergy by 2.5 times compared with other occupational groups. Almost all medications used in clinical practice can cause allergic reactions to the health staffs. Antibiotics were major cause and allergic reactions to familiar beta-lactams happened in the health staffs via contact. Main clinical symptoms of drug allergy were urticaria, prurigo, vomitting, nause and erythema with 3 main syndromes: urticaria, quincke edema and allergic dermatitis. Allergic reactions in health staffs of hospital are needed to pay more attention. Conclusion: the prevalence of drug allergy in Bach Mai Hospital staffs is high and these subjects should be protected from this condition.

Study on allergic reactions due to specific for gout's treatment at the department of allergology and clinical immunology of Bach Mai hospital

Author studied 21 allergic patients due to specific for Gout'streatment from 1995 to 2001 at the Department of Allergology and Clinical Immunology of Bach Mai Hospital with method "cross- sectional surveys". Results showed that: - Allopurinol, colchicin and both go together are specific for Gout'streatment and It caused of. allergic reactions of 21 patients. - Main symptoms of allergic patients of specific for Gout'streatment were erythema, itching and fever The main clinical form is Erythrodermie; Allergic reations were mostly nappened late (after 24 hours); Elevated ESR, white blood cell, uremia, SGOT SGPT and proteinuria are main changes of tests. -It takes a long time to treat allergic patients (13,54 :t 10,17 days); Solution of methyl-prednisolon and dimedrol are common medications to treat this patients; No allergic patient is died due to the specific for Gout'streatment at The Departma

A Case of Ant Sting by Crematogaster Matsumurai Vagala

Reactions from stinging insects are significant to dermatologists because of the wide variety of clinical presentations from mild local reaction to severe anaphylactic reaction. Although ant sting commonly occurs, it has been rarely reported in the literatures. We experienced a unique case with allergic reactions by the ant of the Cremawgaster iw6w urai vagala, subfamily Myrmicinae, family Formicidea, order Hymenoptera that has not been previously reported.