KAAACI Allergic Rhinitis Guidelines: Part 1. Update in pharmacotherapy

The prevalence of allergic rhinitis (AR) and the socioeconomic burden associated with the medical cost and quality of life of AR have progressively increased. Therefore, practical guidelines for the appropriate management of AR need to be developed based on scientific evidence considering the real-world environment, values, and preferences of patients and physicians. The Korean Academy of Asthma, Allergy and Clinical Immunology revised clinical guidelines for AR to address key clinical questions of the management of AR. Part 1 of the revised guideline covers the pharmacological management of patients with AR in Korea. Through a meta-analysis and a systematic review, we made 4 recommendations for AR pharmacotherapy, including intranasal corticosteroid (INCS)/intranasal antihistamine combination therapy, oral antihistamine/INCS combination therapy, leukotriene receptor antagonist treatment in AR patients with asthma, and prophylactic treatment for patients with pollen-induced AR. However, all recommendations are conditional because of the low or very low evidence of certainty. Well-designed and strictly executed randomized controlled trials are needed to measure and report appropriate outcomes.

Comparison of one-bag and multibag desensitization protocols for the prevention of rituximab hypersensitivity

Purpose@#Rituximab is prone to infusion-related reactions, which commonly requires desensitization to maintain its administration. Conventional desensitization protocols are using multistep infusion by diluting solutions. However, the process of diluting drugs and stepwise delivery needs additional time and effort. The objective of this study was to investigate the safety and efficacy of a nondiluting, one-bag protocol of rituximab desensitization. @*Methods@#A retrospective study was performed by reviewing the medical records of patients who underwent rituximab desensitization between 2009 and 2018. The completion rate, occurrence and severity of breakthrough reactions (BTR), and time required to complete the therapy were compared between one-bag protocol and multibag protocol. Results were analyzed by generalized estimation equation method, and odds ratios (ORs) of completion rate and BTR incidence were estimated. @*Results@#Total 190 cases of desensitization therapy were performed in 49 patients; the incidence of BTR was 16.84% and the overall completion rate was 96.32%. No significant difference in completion rate was found (OR, 3.58; 95% confidence interval [CI], 0.79– 16.38) and there was no significant difference in BTR incidence (OR, 0.81; 95% CI, 0.23–2.82) in one-bag protocol. BTR in the one-bag protocol tended to occur even through entire steps, whereas most of the BTR in the multibag protocol occurred at later steps of the process. The average time spent in the desensitization was 60 minutes shorter in the one-bag than the multibag protocol (258.15 minutes vs. 329.81 minutes, P< 0.001). @*Conclusion@#One-bag desensitization protocol showed no significant difference in safety and efficiency compared to the conventional multibag protocol, with shortening the time required for completion.

Iodinated contrast media-induced fixed drug eruption

Iodinated contrast media (ICM) can cause not only immediate onset hypersensitivity but also delayed onset hypersensitivity. While the most common form of delayed onset hypersensitivity reaction to ICM is exanthematous eruption, fixed drug eruption (FDE) can occur rarely related to ICM. A 70-year-old male with liver cirrhosis and hepatocellular carcinoma repeatedly experienced erythematous patches on his right forearm and hand 6 hours after exposure to iopromide for computed tomography scan. ICM induced FDE was diagnosed clinically. Intradermal test with 6 kinds of ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, and iodixanol) was performed and showed the weakest positive reaction to iohexol compared to the others in 48 hours. After changing iopromide to iohexol based on these results, FDE did not recur. We report here a case of iopromide induced FDE which was successfully prevented by changing ICM to iohexol based on intradermal test results.

ERRATUM: Acknowledgments Correction. Iodinated contrast media-induced fixed drug eruption

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