ABSTRACT
BACKGROUND: Oral immunotherapy (OIT) is a promising treatment for food allergies. Our aim was to establish the long-term safety and efficacy of a novel red meat (RM) OIT in galactose-alpha-1,3-galactose (alpha-gal) allergy in adults. METHODS: Out of 20 patients with confirmed RM allergy, five (41.66%) underwent an early OIT, seven (58.33%) underwent a delayed protocol and eight patients who were not desensitized formed the patient control group. 15 and 27 day RM OIT for early-onset and delayed-onset alpha-gal allergy were administered, respectively. Desensitized patients were recommended to continue eating at least 100 g RM every day for 6 months and every other day in the following 6 months. After a year, the consumption was recommended 2/3 times in a week. Patients were followed up with skin tests with commercial beef and lamb extracts, fresh raw/cooked beef and lamb and cetuximab and also with serum alpha-gal specific Immunoglobulin-E (sIgE) in the first and fifth years. RESULTS: All patients who underwent OIT became tolerant to RM. During the 5 year follow-up, the median alpha-gal sIgE concentration gradually decreased in nine patients who consumed RM uneventfully while remained unchanged in the control group (p = .016). In two patients, rare tick bites acted as inducers of hypersensitivity reactions with concomitant elevation of alpha-gal sIgE concentrations whereas one patient with low follow-up alpha-gal sIgE concentrations consumed RM uneventfully after frequent tick bites. CONCLUSIONS: Our study showed the long-term safety and efficacy of alpha-gal OIT. Additionally, alpha-gal sIgE seems to be a potential biomarker to monitor OIT.
Subject(s)
Food Hypersensitivity , Red Meat , Tick Bites , Adult , Cattle , Humans , Animals , Sheep , Galactose , Tick Bites/therapy , Food Hypersensitivity/diagnosis , Food Hypersensitivity/therapy , Red Meat/adverse effects , Allergens , Biomarkers , Immunotherapy , Immunoglobulin E , Meat/adverse effectsABSTRACT
BACKGROUND: Asthma is a heterogeneous disease that presents with different clinical phenotypes. We aimed to compare the patients with asthma diagnosis alone with the patients, who, in addition to their asthma had accompanying analgesic intolerance (AI), chronic urticaria (CU) or seasonal rhinitis (SR) if there are any distinctions and specific characteristics of these defined patient groups. METHODS: Eighty-four asthma patients diagnosed with SR, 46 with CU, 75 with AI and 71 patients with asthma alone were enrolled to the study retrospectively. The reference group for the comparisons was the group with asthma diagnosis alone. RESULTS: The mean age of all patients was 37.2±13 (15-80) and 70.7% of them were females. Asthma patients with SR had a significantly earlier onset of asthma (age: 27.4±10.8 and 34.5±15.9; respectively, p<0.01), significantly better pulmonary function tests and were significantly more atopic (92.9% and 28.8%; p<0.001). Moderate-to-severe asthma significantly correlated with older age at the time of diagnosis, older age of asthma onset, higher body mass index, less atopy and fewer pollen sensitivity. Asthma severity of patients with SR was significantly milder than the reference group (OR: 0.6, 95% CI 0.5-0.8). Asthma with AI tended to be more severe although the relation was insignificant (OR:1.6 95% CI:0.8-3.5). CONCLUSIONS: Asthma patients with SR have significantly milder and earlier onset of asthma, better pulmonary function tests and are significantly more atopic while asthma with AI tends to be more severe. Asthma with CU does not show a specific phenotypic characteristic.
Subject(s)
Analgesics/adverse effects , Asthma/epidemiology , Drug Hypersensitivity/epidemiology , Rhinitis, Allergic, Seasonal/epidemiology , Urticaria/epidemiology , Adolescent , Adult , Age Factors , Age of Onset , Aged , Aged, 80 and over , Allergens/adverse effects , Asthma/complications , Asthma/diagnosis , Asthma/physiopathology , Body Mass Index , Disease Progression , Drug Hypersensitivity/complications , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/physiopathology , Female , Humans , Male , Middle Aged , Pollen/adverse effects , Respiratory Function Tests , Rhinitis, Allergic, Seasonal/complications , Rhinitis, Allergic, Seasonal/diagnosis , Rhinitis, Allergic, Seasonal/physiopathology , Urticaria/complications , Urticaria/diagnosis , Urticaria/physiopathologyABSTRACT
BACKGROUND: Allergic reactions to antibiotics are common in daily clinical allergy practice. Oral drug provocation tests (ODPT) are used to determine safe alternative antibiotics in addition to diagnostic purposes. In one of our previous studies, we have shown that triple test was a safe, time-saving and cost-effective method for determining safe alternatives for patients with non-steroidal anti-inflammatory drug (NSAID) hypersensitivity. OBJECTIVE: Our aim was to investigate the safety of one day two or three antibiotic ODPT performed to find safe alternative antibiotics in antibiotic/NSAID hypersensitive patients, as a cost effective and time saving alternative to conventional one day one antibiotic ODPT. METHODS: Fifty-three patients were enrolled into this survey between 1 September 2005 and 31 December 2006. Double and triple tests are defined as performing ODPT with two and three antibiotics consecutively on the same day. RESULTS: Mean age of the patients was 41.3 +/- 11.7 years and 71.7 % were females. Beta-lactams (41.5 %) were the antibiotics most commonly causing reactions and the most common reaction was urticaria (68.8 %). Double test was performed in 26 (ciprofloxacin + clarithromycin, ciprofloxacin + tetracyline, clarithromycin + tetracycline, ciprofloxacin + ampicillin and ciprofloxacin + roxithromycin) and triple test in 27 patients (ciprofloxacin + tetracycline + clarithromycin, ciprofloxacin + tetracycline + ampicillin, clarithromycin + tetracycline + clindamycin and clarithromycin + ciprofloxacin + ampicillin). Only four patients had positive reactions during triple and double tests. There were no serious adverse reactions. Sixty-five days have been spent with triple-double tests where it would be 136 days with the conventional method. CONCLUSION: The triple-double ODPT performed with antibiotics in antibiotic/NSAID hypersensitive patients with the purpose of determining a safe alternative antibiotic could be a safe, cost-effective and time-saving alternative to conventional one day one antibiotic ODPT.
Subject(s)
Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/immunology , Diagnostic Tests, Routine , Drug Hypersensitivity/diagnosis , Adult , Anti-Bacterial Agents/administration & dosage , Drug Hypersensitivity/etiology , Drug Hypersensitivity/immunology , Female , Humans , Male , Middle AgedSubject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cyclooxygenase 2 Inhibitors/adverse effects , Diclofenac/analogs & derivatives , Administration, Oral , Cyclooxygenase 2 Inhibitors/administration & dosage , Diclofenac/administration & dosage , Diclofenac/adverse effects , Female , Humans , Middle AgedABSTRACT
Adverse skin reactions to drugs are frequent, with rates of reaction to many commonly used drugs exceeding 1%. We describe a 29-year-old woman admitted with a history of itching, rash, vesicles on her hands and soles, and edema on her tongue and oropharynx after trimethoprim-sulfamethoxazole, ciprofloxacin, methenamine anhydromethylene citrate, piroxicam, azithromycin, and ceftriaxone intake. Erythema multiforme (EM) was diagnosed by skin biopsy after oral challenge with piroxicam. EM lesions reappeared after oral challenge with levofloxacin. Although EM is quite common with trimethoprim-sulfamethoxazole and there are some reports of EM appearing after intake of ciprofloxacin, it has rarely been attributed to piroxicam and no reports have identified levofloxacin as a cause.
