Low frequency of hypersensitivity reactions to abacavir in HIV infected patients in a referral center in Bahia, Brazil

Abstract Abacavir can cause a multi-systemic hypersensitivity reaction (HSR) in 5-8% of the patients, which is related to HLA-B*57-01 allele. In Brazil, the HLA-B*57-01 screening test became available only in March 2018, several years after abacavir was in use. In this retrospective study we reviewed medical charts of all patients receiving an abacavir-containing regimen to evaluate the frequency of HSR in patients followed at a referral center in Salvador, Brazil. A total of 192 patients who received abacavir were identified, most male (67.1%), black or racially mixed (77.8%), and having diagnosis of a previous AIDS defining conditions (83.7%). Only one patient developed HSR (incidence: 0.52%). The main reasons for abacavir-containing antiretroviral therapy discontinuation were virological failure (28%), adverse effects to other components of the regimen (25%), and simplification of therapy (16%). The low incidence of HSR to abacavir does not support the use of HLA-B*57-01 screening test, in Salvador, Brazil.

Specific questionnaire detects a high incidence of intra-operative hypersensitivity reactions

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.

Perioperative anaphylaxis / Anafilaxia perioperatória / Anafilaxia perioperatoria

Anaphylaxis remains one of the potential causes of perioperative death, being generally unanticipated and quickly progress to a life threatening situation. A narrative review of perioperative anaphylaxis is performed.

A anafilaxia continua sendo uma das causas potenciais de morte perioperatória, pois geralmente não é prevista e evolui rapidamente para uma situação ameaçadora da vida. Uma revisão da anafilaxia perioperatória é feita.

La anafilaxia sigue siendo una de las causas potenciales de muerte perioperatoria por ser generalmente no anticipada, y progresar rápidamente a una situación amenazante de la vida. Se realiza una revisión de la anafilaxia perioperatoria.

Reacciones adversas inmediatas en el uso de medios de contraste radiológicos no iónicos / Inmediate adverse reactions in the use of non ionic radiological contrast media

Las reacciones adversas a los medios de contraste utilizados en exámenes radiológicos son consideradas una de las variables que deben ser conocidas manejadas para evitar complicaciones y efectos nocivos en los pacientes. El objetivo de este trabajo fue establecer el comportamiento de las reacciones adversas al medio de contrate no iónico en los pacientes expuestos en el Hospital Regional de Concepción mediante un estudio de corte transversal en el que la muestra estuvo compuesta por 167 pacientes a los que se les inyectó un medio de contraste no iónico. En la recolección de datos se aplicó una encuesta y se observó su reacción. Resultados: Las reacciones adversas leves estuvieron presentes en un 16,2 por ciento (n=27), solo una de ellas fue moderada. Al analizar las variables estudiadas: edad, sexo, antecedentes alérgicos, volumen de medio contraste utilizado y exposición previa a medio de contraste anterior, no se encontraron diferencias estadísticamente significativas. Conclusiones: Llama la atención la cantidad de reacciones adversas, que para esta muestra resulta ser muy superior a cualquiera de las publicaciones encontradas. Esto alienta a proponer una nueva investigación en este ámbito considerando que se trata de identificar la realidad local y es un aporte para nuestra población , en cuanto al mejorar la calidad de la atención en base a un perfil nacional, incorporando para un próximo estudio variables del tipo estilo de vida, antecedentes de pueblos originarios y patología asociada, entre otros.

The adverse reactions to the contrast media used in radiological examinations are considered to be one of the variables that they muist be known and handled to avoid complications and harmful effcts in the exposed patients. The objective of this work was to establish the behavior of theadverse reactions to the way of nonionic contrast media in the patients exposed in the Regional Hospital Of Concepción by menas of a study of transverse cut in which the sample was composed by 167 patients to whom they there was injected a way of nonionic contrast media. In the compilation of information a survey was applied and the reaction was observed. Results: The adverse slight reactions were presents in 16,2 percent (n=27), only one them was moderate. When the studied variables analyzed age, sex, allergic precedents, volume of way of used differences. Conlusions: It is called the attention the quatity of adverse reactions, which for this samples turn out to be very superior to any of the opposing publications. This breathes to proposea new investigations in this area thinking that it tries of identifying the local reality and being a contribution for our population, as for improving the quality of the attention on the basis of a national profile, incorporating for a next study variables of the type way of life, precedents of original peoples and associate pathology, between others.

Protocolo de farmacovigilancia a reacciones de hipersensibilidad a medicamentos: resultados de su aplicación en 5 centros de Santiago / Pharmacovigilance protocol for cutaneous drug hypersentivity reactions in Santiago, Chile

Introducción: Las Reacciones de Hipersensibilidad Medicomentosa (RHM) son un motivo de consulta muy común en Dermatología. Con el objetivo de implementar la farmacovigilancia dentro de la Sociedad Chilena de Dermatología (SOCHIDERM) se creó un Protocolo paro la notificación de RHM de tipo muco-cutáneo. Objetivo: Validar una propuesta de Protocolo de Farmacovigilancia de RHM de tipo mucocutáneo de la SOCHIDERM paro el uso de dermatólogos y médicos de nuestro país. Resultados: En nuestro estudio, la frecuencia de RHM fue 0,3% -0,5% del total de consultas ambulatorias y 5,2% 17,2% de las interconsultas a Dermatología. Los patrones más frecuentes fueron el urticarial, morbiliforme y la reacción medicamentosa fija. Los fármacos imputados con mayor frecuencia fueron los analgésicos/antiinflamatorios, los fármacos con acción en el sistema nervioso central, los antibióticos y los antihipertensivos. Discusión: Es importante tener un Protocolo de Farmacovigilancia. Esto nos permitirá obtener datos a nivel nacional. El desafío a corto plazo paro farmacovigilancia en SOCHIDERM es lograr notificar las RHM de tipo muco-cutáneo graves o con compromiso vital, que sean atendidas por dermatólogos en nuestro país, a través del Protocolo de Farmacovigilancia SOCHIDERM.

Introduction: Drug Hypersensitivity Reactions (DHR) are a common cause of consultation in dermatology. In order to implement fharmacovigilance in the Chilean Society of Dermatology (SOCHIDERM), we created a protocol for the notification of mucocutaneous DHR. Objective: To validate a SOCHIDERM mucocutaneous DHR pharmacovigilance protocol for dermatologists and physicians in our country. Results: In our study. DHR accounted for 0.3-0.5 % of all outpatient consultations, and 5,2-17,2% of interconsultations in dermatology. The most frequent patterns were urticarial, morbilliform and fixed drug reaction. The drugs most frequently involved were analgesics/anti-inflammatory drugs with action in the central nervous system, antibiotics and antihypertensives. Discussion: It is important to have a Pharmacovigilance Protocol since it will allow to obtain nationwide data. The short-term challenge for the SOCHIDERM pharmacovigilance is to notify serious or life-threatening mucocutaneous DHR that have been seen by dermatologists in our country, through this Protocol.

Drug hypersensitivity in students from São Paulo, Brazil

BACKGROUND: Drug hypersensitivity is responsible for substantial mortality and morbidity, and increased health costs. However, epidemiological data on drug hypersensitivity in general or specific populations are scarce. METHODS: We performed a cross-sectional survey of 1015 university students, using a self-reported questionnaire. RESULTS: The prevalence of self-reported drug hypersensitivity was 12,11 percent (123/1015). The most frequently implicated drugs were non-steroidal anti-inflammatory drugs (45,9 percent) and beta-lactam and sulfonamide antibiotics (25,40 percent). The majority of the patients reported dermatological manifestations (99), followed by respiratory (40), digestive (23) and other (19). Forty-five patients had an immediate type reaction, and 76,72 percent (89) had the drug by oral route. CONCLUSION: The results showed that drug hypersensitivity is highly prevalent in university students, and that nonsteroidal anti-inflammatory drug and antibiotics (beta-lactams and sulfonamide) are the most frequently concerned drugs.

The utility of the World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) system for the assessment of adverse drug reactions in hospitalized children.

Although the World Health Organization-The Uppsala Monitoring Centre (WHO-UMC) system has been suggested as a practical tool for classifying adverse drug reactions (ADRs), verification of such system has not been examined. The objective of this study was to evaluate the usefulness of the WHO-UMC classification for the diagnosis of ADRs. The gold standard was the results of drug challenges and serum tryptase in cases of anaphylaxis. Twenty-seven children had ADRs classified by the WHO-UMC system. The causality terms were 'certain' in 4/27, 'probable' in 6/27, 'possible' in 10/27 and 'unlikely' in 7/27 of the patients. Skin prick tests and intradermal tests were positive in 1/20 and 1/5 of the patients, respectively. Drug challenges and serum tryptase were positive in 8/26 and 1/3 of the patients, respectively. After complete evaluation, the positive and negative ADRs were documented in 9/27 patients (33.33%) and 18/27 patients (66.67%), respectively. The multi-level likelihood ratios for ADRs using the WHO-UMC system were infinity in causality term 'certain', 2 in 'probable', 0.5 in 'possible', and 0 in 'unlikely'. In conclusion, causality term 'certain' and 'unlikely' of the WHO-UMC system had large impact on the likelihood of ADRs. In contrast, the causality term 'probable' and 'possible' had small impact on the likelihood of ADRs. Drug challenges and serum tryptase were helpful to confirm ADRs categorized by WHO-UMC system.

Management of the patient reporting an allergy to penicillin

Recent emphasis on the prevention of surgical wound infection has highlighted the role of the anesthesiologist as the physician responsible for administering appropriate antibiotic prophylaxis. Patients often report a distant or unclear history of penicillin allergy. Administering an antibiotic to which the patient has a true allergy can provoke a life threatening reaction. The anesthesiologist should be aware of the prevalence, severity, and manifestations of allergies to antibiotics, as well as the available alternatives. Unnecessary administration of more powerful broad-spectrum antibiotics leads to the development of antimicrobial resistance and should be avoided. It is the anesthesiologists' duty to balance these issues when selecting appropriate antibiosis

Alergia a beta-lactámicos / Allergy to betalactams

La alergia a b-lactámicos es la primera causa de alergia medicamentosa en el mundo. En nuestro país, el estudio in vivo (pruebas cutááneas) realizado regularmente no se efectúa de acuerdo a patrones internacionales establecidos. Este artículo revisa el diagnóstico y manejo de estas reacciones. Las reacciones alérgicas a b-lactámicos pueden clasificarse, según su perfil temporal, en inmediatas, aceleradas y tardías, lo que se relaciona con las manifestaciones clínicas y mecanismos patogénicos. La mayor parte de las reacciones inmediatas y aceleradas son mediadas por IgE, con expresión clínica de hipersensibilidad inmediata. Entre las reacciones tardías destacan las toxidermias y exantemas máculo-papulares, mediadas probablemente por hipersensibilidad retardada. Los alergenos implicados en las reacciones de hipersensibilidad inmediata a b-lactámicos pueden ser los determinantes mayores (75 por ciento de los casos), determinantes menores o las cadenas laterales de los fármacos sospechosos. El estudio de estos pacientes incluye IgE específicas, pruebas cutáneas y pruebas de provocación. Los objetivos de estos estudios son diagnosticar reactividades cruzadas o monosensibilizaciones, y autorizar o prohibir la utilización de todos los b-lactámicos o sólo algunos de los fármacos del grupo, además de asegurar la tolerancia a fármacos alternativos.

Prevalences of symptoms of asthma and other allergic diseases in korean children: a nationwide questionnaire survey

The purpose of this study was to estimate the national prevalence of childhood asthma and other allergic diseases in Korea, and to determine potential risk factors for the diseases. Stratified random samples of 42,886 were selected from 34 elementary (6-12 yr olds) and 34 middle schools (12-15 yr olds) nationwide, and 38,955 were in the final analysis. The Korean-translated modified version of the International Study of Asthma and Allergies in Childhood questionnaire was used in this cross-sectional survey. Twelve-month prevalences of the symptoms of asthma, rhinoconjunctivitis, and flexural eczema were 8.7%, 10.5%, 7.3% in 6-12 yr olds, and 8.2%, 10.0%, 3.9% in 12-15 yr olds, respectively. For allergic conjunctivitis, food allergy, and drug allergy, the prevalences in 6-12 yr olds were 11.2%, 6.5%, and 1.5%, respectively. Asthma and flexural eczema decreased significantly with age. Other significant risk factors were also noted. For 6-12 yr-old asthma, adjusted odds ratio (aOR) of body mass index was 1.21 with 95% confidence interval (CI) 1.0-1.48, aOR of passive smoking was 1.37 with 95%CI 1.24-1.51, aOR of carpet use was 1.28 with 95%CI 1.10-1.49. For 6-12 yr-old eczema, aOR of affluence was 1.22 with 95%CI 1.07-1.39. The control of obesity and passive smoking would be the most important preventive measures of allergic diseases.

Achados clínicos da sensibilidade a analgésicos e antiinflamatórios näo-hormonais / Clinical findings of sensitivity to analgesics and nonsteroidal antiinflammatory drugs

Analgésicos (ANA) e antiinflamatórios nao-hormonais (AINH) podem causar reaçoes que simulam as alérgicas ou agravam asma e urticária. OBJETIVO: Verificar as manifestaçoes clínicas de pacientes com história de reaçao a analgésicos (ANA) e antiinflamatórios nao-hormonais (AINH). MÉTODO: Análise e retrospectiva de prontuários de 183 pacientes com história de sensibilidade a ANA e AINH. RESULTADOS: Eram 93 (51 por cento) pacientes do sexo feminino e 90 (49 por cento) do sexo masculino; 63 (34 por cento) com idade igual ou inferior a 15 anos e 120 (66 por cento) com idade superior a 15 anos. Havia um predomínio de pacientes do sexo feminino com idade superior a 15 anos que foi estatisticamente significativo (p = 0,02). A idade por ocasiao da primeira reaçao com medicamentos variou de 7 meses a 65 anos (média de 15 anos). Testes cutâneos para aeroalérgenos foram positivos para pelo menos um alérgeno testado em 100/138 (72 por cento). As manifestaçoes clínicas encontradas foram angioedema (86 por cento), urticária (39 por cento), reaçoes sistêmicas (30 por cento), reaçoes nasais e oculares (15 por cento) e crise de asma (14 por cento). Nao havia diferença quanto à freqüência de sintomas com relaçao à idade. Havia história familiar de sensibilidade a ANA/AINH em sete pacientes (3,8 por cento). As doenças associadas foram rinite (55 por cento), urticária crônica (47 por cento), asma (37 por cento) e conjuntivite (17,5 por cento). As drogas causavam crise de asma com maior freqüência em asmáticos do que em nao asmáticos (p = 0,001). Reaçoes repetidas a mais de uma droga ocorreram em 107 (58 por cento) pacientes. CONCLUSOES: Reaçoes a ANA e AINH foram freqüentes em atópicos; crianças e adultos reagiam igualmente; foram mais comuns em adultos do sexo feminino; angioedema palpebral foi a manifestaçao clínica mais freqüente; broncoespasmo foi mais comum nos asmáticos e a maioria dos pacientes tinha reaçoes repetidas a mais de uma droga

Reacciones a medios de contraste yodados sin muertes. Experiencia durante 29 años / Yodate contrast media reactions. Experience of 29 years

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

Allergic reactions to phenytoin in a general hospital in Singapore.

Phenytoin is used for the treatment and prevention of fits. We investigated all patients reported to have phenytoin allergy in our hospital and found 42 confirmed cases. Sixty-nine percent were female and 83.3% were Chinese. The mean age of the patients was 46.5 years. The reactions reported were maculopapular rash (71.4%), Stevens-Johnson syndrome (14.3%), fever (4.8%), generalized exfoliative dermatitis (2.4%), toxic epidermal necrolysis (2.4%), vasculitis (2.4%) and agranulocytosis (2.4%). In conclusion, the majority of reported allergic reactions to phenytoin were cutaneous (92.9%) and one fifth of these were potentially life-threatening.

Surveillance of drug induced diseases in children.

A hospital based prospective study on drug induced diseases (DID) in children below 14 years of age was done for a duration of two years. A total number of 20,310 patients were examined in pediatric department during this period, out of which 204 (1.004%) patients were diagnosed as DID. Children with severe reactions were admitted in pediatric ward for in hospital intensive surveillance. The male:female ratio in DID was 1.2:1. DID were most common in neonates (24.51%). Erythmatous maculopapular rashes (67.12%) formed the most common pool of DID in neonates. Thrombophlebitis (41.56%) was most commonly seen in infants above 28 days of life, and in children up to 14 years of age. Out of 204 cases of DID, 9 (4.41%) died. Aplastic anemia was most morbid DID, as all the 7 patients of aplastic anemia died. Chloramphenicol was responsible for all the cases of aplastic anemia. Other two deaths were from erythma multiforme and C.C.F. The most commonly involved drugs, other substances and vaccines were baby powders, massage oils, ampicillin, co-trimoxazole, i.v. infusions (electrolytes and mannitol), DPT and measles vaccines.

Teste de provocaçäo brônquica com inalaçäo de aspirina lisina / Bronchial provocation test with aspirin lysine inhalation

A avaliaçäo da reatividade brônquica com aspirina lisina é sugerida como método diagnóstico para pacientesasmáticos com história prévia de sensibilidade à aspirina. Com o objetivo de avaliar a eficácia e viabilidade desse teste, foram estudados 16 indivíduos com média de idade de 28 anos, divididos em dois grupos. O primeiro grupo (grupo AAS), formado por nove pacientes com história sugestiva de asma induzida por aspirina, e o segundo (grupo controle), por sete indivíduos incluídos nesse protocolo foram submetidos, no laboratório de funçäo pulmonar, a duas fases de estudo. Primeiro, ao teste de broncoprovocaçäo com histamina, e após um intervalo de no mínomo quatro dias, à medida de reatividade brônquica com aspirina lisina. No grupo AAS, todos os pacientes apresentaram broncoprovocaçäo positiva com aspirina lisina, enquanto no grupo controle os testes com aspirina foram foram negativos. A tolerância ao exame foi satisfatória, sendo o broncoespasmo, quando presente, controlado com fenoterol 'spray'. Concluímos que a broncoprovocaçäo com aspirina lisina é um método diagnóstico eficaz e seguro em pacientes asmásticos com história de sensibilidade oral à aspirina

Adverse drug reactions in pediatrics with a study of in-hospital intensive surveillance.

A two-part prospective study of adverse drug reactions (ADRs) in Indian children was carried out at a teaching general hospital. Using an in-hospital intensive surveillance scheme (IISS) for the detection of ADRs, indoor patients of one of the two units in the pediatric ward were monitored daily for 6 months, with the other unit serving as a control group. A total of 347 patients were monitored, 2781 daily orders written and 24,474 doses of 96 different drugs given. Six patients suffered from ADRs (1.73%), and 1 reaction proved fatal (0.29%), while the control group reported only 1 ADR in the same time period. The frequency of ADRs (p < 0.001) and their resultant mortality in Indian children was less than that in a western prototype study. Though IISS showed a marked increase in ADR reporting, it was too cumbersome for routine use in our country. In the second part of the study, 40 cases of ADRs seen over 2 years were analyzed. Antimicrobials, especially sulphonamides, accounted for a high percentage of cases mostly as skin rashes and fairly severe reactions were common. Patients on anti-tuberculous and anti-convulsant drugs required prolonged supervision for late onset reactions.