ABSTRACT
Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions, but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent. In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure.
Subject(s)
Antineoplastic Agents, Immunological , Drug Hypersensitivity , Neoplasms , Antibodies, Monoclonal/therapeutic use , Antineoplastic Agents, Immunological/therapeutic use , Desensitization, Immunologic , Drug Hypersensitivity/drug therapy , Drug Hypersensitivity/therapy , Humans , Neoplasms/drug therapyABSTRACT
Rapid drug desensitization has enabled first-line therapies in patients with drug hypersensitivity reactions to chemotherapeutic drugs including monoclonal antibodies. Desensitization is a safe and highly effective procedure, not only for IgE-mediated reactions, but also for those mediated by non-IgE mechanisms. The likelihood of breakthrough reactions during desensitization is low, and most are mild; in fact, moderate-to-severe reactions are infrequent. In this document, 16 allergy departments belonging to the Spanish research network ARADyAL present a review of the available scientific evidence and provide general guidelines for the diagnosis and management of drug hypersensitivity reactions to chemotherapeutic drugs and monoclonal antibodies. Emphasis is placed on the desensitization procedure (AU)
La desensibilización a medicamentos ha permitido la administración de fármacos de primera línea en pacientes con reacciones dehipersensibilidad (RH) a quimioterápicos (QT), incluyendo los anticuerpos monoclonales (AcM). La desensibilización es un procedimientoseguro y altamente efectivo, no únicamente para las reacciones mediadas por IgE sino también para aquellas relacionadas con un mecanismoindependiente de IgE. El riesgo de reacciones durante la desensibilización es bajo y frecuentemente las reacciones observadas son leves,considerándose infrecuentes las reacciones moderadas o graves.En este documento, dieciséis Servicios de Alergia pertenecientes a la red española de investigación ARADyAL presentan una revisiónde la evidencia científica disponible y sugieren unas pautas de actuación generales para el diagnóstico y manejo de las RH a QT y AcM,centrándose en el proceso de desensibilización (AU)
Subject(s)
Humans , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Antineoplastic Agents, Immunological , Drug Hypersensitivity/therapy , Drug Hypersensitivity/diagnosis , Desensitization, Immunologic , Neoplasms/drug therapyABSTRACT
No disponible
Subject(s)
Humans , Female , Vulvovaginitis/diagnosis , Hypersensitivity/diagnosis , Anaphylaxis/etiology , Kallikreins/adverse effects , Postmenopause , Hypersensitivity/etiology , Human-Animal Bond , Dogs , Diagnosis, DifferentialSubject(s)
Actins/adverse effects , Allergens/adverse effects , Food Hypersensitivity/etiology , Seafood/adverse effects , Snails/immunology , Actins/immunology , Allergens/immunology , Animals , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Humans , Immunoglobulin E/blood , Immunoglobulin E/immunology , Middle Aged , Skin TestsABSTRACT
BACKGROUND: Food allergy is a very frequent and increasingly common disease in children and adolescents. It affects quality of life and can even be life-threatening. Given that 10-18% of allergic/anaphylactic food reactions take place in schools, it is essential to provide school personnel with training on the management of reactions. METHODS: The Allergy Unit of Hospital Universitario de Fuenlabrada, Spain, organized a conference entitled "Management of Food Allergy in Children and Adolescents in School Centers" during which teachers, cooks, cafeteria monitors, and summer-camp leaders underwent a training course. Attendees filled out a questionnaire with eight questions before and after the course to assess their self-efficacy in management of food allergy and anaphylaxis. The results were compared. RESULTS: A total of 191 people participated (51% dining-room monitors, 24% teachers, 13% cooks, and 12% other professions). The areas in which the attendees presented the lowest confidence before receiving the course were recognition of symptoms and treatment of the reactions/anaphylaxis. The mean score for each of the eight concepts evaluated improved after the training course. This improvement was significant in the management of anaphylaxis. CONCLUSIONS: Our study demonstrates the usefulness of a self-efficacy scale in school personnel as a tool to assess the ability to manage food allergy and anaphylaxis. It can help to identify problem areas in which more specific training programs can be implemented.
Subject(s)
Anaphylaxis/epidemiology , Food Hypersensitivity/epidemiology , School Teachers , Schools , Teacher Training , Adult , Education, Professional , Efficiency, Organizational , Epinephrine/administration & dosage , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Middle Aged , Spain/epidemiology , Surveys and Questionnaires , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Shellfish Hypersensitivity/immunology , Actins/isolation & purification , Allergens/isolation & purification , Tropomyosin/isolation & purification , Food Hypersensitivity/immunology , Skin Tests/methodsSubject(s)
Erythema Multiforme/chemically induced , Erythema Multiforme/drug therapy , Etanercept/therapeutic use , Pregnenediones/adverse effects , Erythema Multiforme/immunology , Etanercept/immunology , Humans , Male , Middle Aged , Pregnenediones/immunology , Stevens-Johnson Syndrome/drug therapy , Stevens-Johnson Syndrome/immunologyABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Erythema Multiforme/chemically induced , Etanercept/therapeutic use , Drug-Related Side Effects and Adverse Reactions/drug therapy , Adrenal Cortex Hormones/adverse effects , Patch Tests/methods , Intradermal TestsABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Cucurbitaceae/adverse effects , Food Hypersensitivity/diagnosis , Plant Epidermis/adverse effects , Skin Tests , Cross-Priming/immunologySubject(s)
Drug Hypersensitivity/diagnosis , Electronic Health Records , Food Hypersensitivity/diagnosis , Hospital Information Systems , Reminder Systems , Critical Pathways , Cross-Sectional Studies , Drug Hypersensitivity/epidemiology , Food Hypersensitivity/epidemiology , Humans , Prevalence , Risk Factors , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Male , Female , 34660 , Hypersensitivity/epidemiology , Hypersensitivity/prevention & control , Electronic Health Records/organization & administration , Electronic Health Records/standards , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity/immunology , Electronic Health RecordsABSTRACT
BACKGROUND: The relevance of contact allergy to plant-related food has recently emerged. Oral allergy syndrome is one of the most characteristic symptoms of fruit allergy, although it also causes systemic reactions. Plant-food allergy is increasing at the same time as pollen allergy, and fruit-induced allergic contact urticaria could be rising as well. OBJECTIVES: The present study was carried out in order to investigate whether one particular primary melon-peel allergen is responsible for contact urticaria. METHODS: Fourteen patients presenting with contact urticaria after touching melon peel were evaluated. A melon-peel extract was prepared and analysed by immunoblotting using the patients' sera. Molecular characterization of IgE-binding bands was performed using mass spectrometry. Melon-peel lipid transfer protein (LTP) was purified. Inhibition studies and contact challenge with the protein were performed to confirm IgE reactivity to the purified allergen. RESULTS: An IgE-binding band of ~8-9 kDa was observed in an immunoblotting assay with all the patients' sera and was identified as an LTP. The melon-peel LTP was purified in two chromatography steps. Inhibition studies confirmed LTP as a major allergen in patients with melon-peel contact urticaria. Contact challenge with melon-peel LTP was performed in five patients, all of whom had positive results, exhibiting itchy erythema and hives in the area of contact. CONCLUSIONS: This study confirmed our previous findings that melon-peel LTP is a major allergen and is responsible for contact allergy. This knowledge may be used to improve both diagnosis and treatment of patients allergic to melon.
Subject(s)
Antigens, Plant/adverse effects , Carrier Proteins/adverse effects , Cucurbitaceae/adverse effects , Dermatitis, Allergic Contact/etiology , Food Hypersensitivity/etiology , Plant Proteins/adverse effects , Urticaria/etiology , Adolescent , Adult , Allergens/adverse effects , Child , Female , Humans , Immunoglobulin E/metabolism , Male , Middle Aged , Protein Binding , Skin Tests , Young AdultSubject(s)
Humans , Male , Female , Profilins/adverse effects , Profilins , Profilins/immunology , Allergy and Immunology/instrumentation , Hypersensitivity/diagnosis , Hypersensitivity/drug therapy , Pollen/adverse effects , Pollen/immunology , Blotting, Western/methods , Blotting, Western/standards , Blotting, Western , Skin Tests/instrumentation , Skin Tests/methods , Skin TestsABSTRACT
BACKGROUND: The pentavalent antimonials are considered the first-choice drugs for treatment of leishmaniasis. Intralesional therapy is used to minimize the systemic effects of the drug. METHODS: Seventy patients were treated with weekly intralesional infiltrations of Glucantime(®) (meglumine antimoniate) for cutaneous leishmaniasis. Nine of them had infiltrated itchy erythematous and vesiculous plaques at the injection sites. Cutaneous tests were undertaken in eight patients. RESULTS: Prick tests were negative and seven of the eight patients showed positive intradermal tests with Glucantime(®) dilutions reading at D2 and D4. Only one patient had positive patch test to Glucantime a.i. Local reactions at the site of injection have been briefly mentioned in some reported series of leishmaniasis treated with intralesional or intramuscular meglumine antimoniate but the mechanism has never been explained before. CONCLUSIONS: We report the first series of patients with local reactions at the injection sites of meglumine antimoniate in whom type IV hypersensitivity could be involved.
