ABSTRACT
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided
ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS
Subject(s)
Humans , Drug Hypersensitivity Syndrome , Drug Hypersensitivity Syndrome/diagnosis , Drug Hypersensitivity Syndrome/prevention & control , Drug Hypersensitivity Syndrome/therapy , SpainABSTRACT
No disponible
Subject(s)
Humans , Red Meat/adverse effects , Food Hypersensitivity/immunology , Hypersensitivity, Immediate/immunology , Creatine Kinase/immunology , Swine , Allergens/immunology , Case-Control StudiesABSTRACT
No disponible
Subject(s)
Humans , Male , Adult , Actins/immunology , Cross Reactions/immunology , Food Hypersensitivity/immunology , Allergens/isolation & purification , Fructose-Bisphosphate Aldolase/adverse effects , Skin Tests/methods , Phosphopyruvate Hydratase/adverse effects , Meat/adverse effects , Fish Products/adverse effectsABSTRACT
BACKGROUND: Edema of the uvula (EU) may appear in isolation or in association with clinical manifestations such as urticaria, angioedema, and anaphylaxis. EU may lead to upper airway obstruction, provoking obstructive respiratory distress and asphyxia. OBJECTIVE: We sought to investigate the etiology of and predisposing factors for EU in a large population of patients referred to an outpatient clinic. METHODS: In this 3-year follow-up cohort study, 171 patients presenting with EU were identified and classified as having isolated EU or nonisolated EU. The etiology of each patient's condition was studied, and possible predisposing factors were recorded. An allergology work-up and a statistical study (bivariate/multivariate analyses) were performed. RESULTS: The predisposing factors for both groups of EU patients were found to be different. The etiology of the problem was identified for most patients; allergy to Anisakis simplex was the most common cause in both groups. Nonsteroidal anti-inflammatory drugs and antibiotics were also found to be triggers in both groups. CONCLUSIONS: Isolated EU was associated with snoring, an elongated uvula, and having experienced previous episodes of EU. We found no associations between groups of EU patients and gender, obesity, smoking, alcohol consumption, personal and family history of atopy, and obstructive sleep apnea. Allergy to A simplex was the most commonly recorded cause
INTRODUCCIÓN: El edema de úvula (EU) puede aparecer aislado o en asociación con otras manifestaciones clínicas, tales como urticaria, angioedema o anafilaxia. En cualquier caso, puede provocar una obstrucción de la vía aérea superior que a veces puede ser grave. OBJETIVO: Intentamos investigar la etiología y los factores predisponentes del EU de una gran población de pacientes derivados a nuestras consultas. MÉTODOS: En este estudio de cohortes de 3 años de seguimiento, se valoraron 171 pacientes que presentaban EU, clasificándose como EU aislado o EU no aislado. Se estudió la etiología de la condición clínica de cada paciente y se registraron los posibles factores predisponentes en cada caso, a través de un estudio alergológico y estadístico, con el fin de comprobar una asociación significativa entre ellos. RESULTADOS: Se encontró que los factores predisponentes para ambos grupos de pacientes eran diferentes. Una etiología fue identificada para la mayoría de los casos, siendo la alergia a Anisakis simplex la causa más común para ambos grupos. Los fármacos antiinflamatorios no esteroideos y los antibióticos también fueron identificados como etiologías para ambos grupos. CONCLUSIONES: Encontramos que el EU aislado se asoció con roncopatía, úvula elongada y haber sufrido episodios previos de EU. No se demostró asociación entre ambos grupos de pacientes con el sexo, obesidad, tabaquismo, hábito enólico, atopia personal y familiar o apnea obstructiva del sueño. La alergia a A. simplex fue la causa más frecuentemente demostrada
Subject(s)
Humans , Male , Female , Adolescent , Young Adult , Adult , Middle Aged , Aged , Aged, 80 and over , Edema/epidemiology , Edema/etiology , Uvula/pathology , Disease Susceptibility , Edema/diagnosis , Odds Ratio , Risk Assessment , Risk Factors , Skin Tests , Spain/epidemiology , Prospective Studies , Longitudinal StudiesABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Bronchial Thermoplasty/adverse effects , Bronchitis/diagnosis , Bronchitis/etiology , Asthma/complications , Hypersensitivity, Immediate/complications , Immunoglobulin E/immunology , Prednisone/therapeutic use , Biomarkers/blood , Bronchial Thermoplasty/methods , Bronchitis/drug therapy , Radiography, Thoracic , Severity of Illness Index , Skin TestsABSTRACT
Component-resolved diagnosis based on the use of well-defined, properly characterised and purified natural and recombinant allergens constitutes a new approach in the diagnosis of venom allergy. Prospective readers may benefit from an up-to-date review on the allergens. The best characterised venom is that of Apis mellifera, whose main allergens are phospholipase A2 (Api m1), hyaluronidase (Api m2) and melittin (Api m4). Additionally, in recent years, new allergens of Vespula vulgaris have been identified and include phospholipase A1 (Ves v1), hyaluronidase (Ves v2) and antigen 5 (Ves v5). Polistes species are becoming an increasing cause of allergy in Europe, although only few allergens have been identified in this venom. In this review, we evaluate the current knowledge about molecular diagnosis in hymenoptera venom allergy
No disponible
Subject(s)
Humans , Animals , Allergens/immunology , Arthropod Venoms/immunology , Hymenoptera/immunology , Hypersensitivity/diagnosis , Insect Bites and Stings/immunology , Allergens/analysis , Allergens/chemistry , Arthropod Venoms/chemistry , Hymenoptera/chemistry , Hypersensitivity/immunology , Anaphylaxis/immunologyABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Dimethyl Fumarate/adverse effects , Drug Hypersensitivity/diagnosis , Multiple Sclerosis/drug therapy , Methylprednisolone/therapeutic use , Drug Hypersensitivity/drug therapy , Skin TestsABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Antigens, Plant/isolation & purification , Lipoproteins/isolation & purification , Food Hypersensitivity/diagnosis , Hypersensitivity, Immediate/diagnosis , Helianthus/adverse effects , Seeds/adverse effects , Intradermal TestsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Influenza Vaccines/adverse effects , Vasculitis, Leukocytoclastic, Cutaneous/chemically induced , Drug Hypersensitivity/diagnosis , Purpura/chemically induced , Intradermal Tests/methods , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Flax/adverse effects , Flax/analysis , Food Hypersensitivity/complications , Food Hypersensitivity/diagnosis , Food Hypersensitivity/immunology , Angioedema/chemically induced , Linaceae/adverse effects , Linaceae/immunology , Angioedema/complications , Angioedema/immunology , Methylprednisolone/therapeutic use , Injections, Subcutaneous , Blotting, Western , Anaphylaxis/drug therapy , Anaphylaxis/immunologyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Anaphylaxis/complications , Anaphylaxis/diagnosis , Anaphylaxis/immunology , Anisakis/immunology , Anisakis/isolation & purification , Eosinophilia/blood , Eosinophilia/diagnosis , Immunoglobulin E/analysis , Immunoglobulin E/isolation & purification , Environmental Exposure/adverse effects , Environmental Exposure/standards , Occupational Exposure/adverse effects , Hypersensitivity, Immediate/complications , Hypersensitivity, Immediate/immunologyABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Rosaceae/adverse effects , Hypersensitivity/diagnosis , Plant Extracts/adverse effects , Angioedema/diagnosis , Hypersensitivity, Immediate/diagnosis , Dermatitis, Allergic Contact/diagnosisABSTRACT
No disponible