Diagnosis of immediate hypersensitivity to ß-lactam antibiotics can be made safely with current approaches.

BACKGROUND: Diagnosing immediate hypersensitivity to ß-lactam antibiotics is still a significant problem. Recently, a new penicillin testing reagent was introduced to the market. In this study, the recommendations of the European Network of Drug Allergy (ENDA) for the diagnosis of immediate reactions to ß-lactams were followed, and the negative predictive value of this approach with currently available reagents was assessed. METHODS: Eighty patients (age range: 6-74 years) with a history of immediate reactions to ß-lactams were included. All cases underwent skin testing with benzylpenicilloyl-polylysine (PPL) and minor determinant mixture (MDM), followed by the culprit drug if necessary. If this step was negative, a drug provocation test was offered. If this step also yielded a negative result, then the patients were recommended to use ß-lactam antibiotics in future whenever their use was indicated. RESULTS: Overall, 29 patients (36.2%) were diagnosed as ß-lactam allergic. The majority of the cases (72.4%) were diagnosed by positive skin tests to either PPL or MDM, whereas 10.3% were diagnosed by skin testing with culprit drugs and 17.2% with drug provocation tests. Regarding the use of the tested drug in the long term, almost half of the contacted patients had had an indication to use the tested drug and the majority had taken the whole course without problems. CONCLUSIONS: Although currently available new penicillin tests provide sufficient allergy data, all the steps recommended by ENDA should be followed in the diagnosis of immediate reactions to ß-lactams. If these steps are negative, the patients usually tolerate ß-lactams and only a few develop mild, non-life-threatening reactions in the long term.

Safety of meloxicam in patients with aspirin/non-steroidal anti-inflammatory drug-induced urticaria and angioedema.

It has been proposed that aspirin (ASA) and other non-steroidal anti-inflammatory drug (NSAID)-induced urticaria (UR)/angioedema (AE) are mediated through inhibition of cyclooxygenase-1 (COX-1) enzymes. Therefore, drugs with COX-2 selectivity may be well tolerated in such patients. We investigated the safety of preferential COX-2 inhibitor meloxicam in subjects with UR or AE type intolerance reaction to classical ASA/NSAIDs. Subjects with reliable or documented history of UR/AE due to classical ASA/NSAIDs underwent a single-blinded, placebo-controlled oral challenge with a cumulative dose of 7.5 mg meloxicam on 2 separate days. One-quarter and three-quarter divided doses of placebo and the active drug were given at 1-h intervals. A total of 116 patients (86 women and 30 men, mean age 39.6 ± 12.7 years) were enrolled to the study. The rate of atopy was 25.9%. Mean duration of drug reaction was 87.4 ± 110.8 (1-720) months. Almost half of the patients were multi-reactors. The most comorbid disease was asthma and the two most frequent NSAIDs inducing UR/AE were paracetamol (19. 6%) and ASA (19%). No reaction to placebo was observed. Ten out of 116 patients (8.6%) developed mild UR/AE, or only erythema and pruritus at a one-quarter or cumulative dose of 7.5 mg of meloxicam. The remaining subjects (91.4%) tolerated perfectly meloxicam challenge. This study indicates that 7.5 mg meloxicam is a safe alternative for ASA/NSAID-intolerant UR/AE patients. Intolerance reactions to meloxicam are much milder forms of the patients' historical ASA/NSAID-induced cutaneous reactions.

The prevalence of latex allergy in sixth-year medical students: assessment of knowledge, risk, and attitudes about future specialty direction.

BACKGROUND: In the prevention of latex allergy, knowledge levels and risk determination for latex allergy of medical students gain importance. OBJECTIVES: To evaluate the latex allergy knowledge levels of sixth-year medical students and their latex allergy risk. METHODS: Students completed a questionnaire that assessed basic knowledge of latex allergy and that evaluated latex-related symptoms and latex exposure. The specialty branch students were going to choose in the Medical Specialty Examination was also asked. Skin prick tests (SPTs) with latex and inhalant allergens and patch tests with latex-related products were then performed. Finally, students were asked again about any changes in branch selection after learning their individual risks. RESULTS: Two hundred twenty sixth-year students were enrolled. Forty-four percent of the students gave the right answer for description of latex. Correct identification of at least 1 latex-related product used outside and inside hospitals was 55.5% and 95.5%, respectively. The prevalence of latex sensitization was 4.4% according to SPT results. The positivity of SPT to any inhalant allergen was 35% (n = 64). None of the students changed their mind about their specialty branch after learning their latex allergy risk. CONCLUSIONS: Last-year medical students have a remarkably low latex allergy knowledge level, which imposes a serious professional risk. Training strategies based on the benefit to this risk group and reevaluation are strongly recommended before graduation from medical school.

Risk factors determining allergic airway diseases in Turkish subjects.

With regard to changes in life-style after the 1980s, the reflection of environmental factors on the evolution of allergic airway disease (AAD) has not yet been analyzed in Turkey. In this trial, we aimed to determine the factors related to AAD in Turkish subjects. Patients diagnosed as having asthma and/or rhinitis with positive skin prick tests (SPTs) were accepted as members of the "atopic group" (n = 235). Subjects demonstrated to have negative SPTs and no clinical evidence of any atopic disorder were accepted as members of the "nonatopic control group" (n = 84). Data obtained from a questionnaire applied cross-sectionally to the study groups were compared for risk factor analysis. According to the results of univariate analysis, nonatopic controls were found to have been born in villages more frequently than those in the atopic group (14.3% vs. 4.7%, p = 0.02). Atopic group members had lived in apartments during childhood more frequently than nonatopic controls (53.6% vs. 38%, p = 0.04). A topic group members, particularly the asthmatics, had lower sibship size (< or = 1 sibling) (41.3% vs. 16.7%, p = 0.0003) and nonatopic subjects had higher sibship size (> or = 3 siblings) (73.8% vs. 43.4%, p < 0.0001). The rate of maternal atopy was higher in the atopic group (24.7% vs. 9.5%, p = 0.02). Place of birth, sibship size, and atopic status of the mother, but not house type, were found to be significant in the multivariate analysis. As a conclusion, rural life-style seems to have a protective effect on the development of atopy in Turkey. On the contrary, factors directly or indirectly related to urban life-style during early childhood were found to be associated with the allergic airway diseases.

Clinical features and atopy profile in Turkish subjects with analgesic intolerance.

The factors underlying analgesic intolerance (AI), particularly the role of ethnic characteristics, are readily not clear. In this trial, we aimed to assess the predictive features of AI in Turkish subjects. One hundred and ninety patients with AI were enrolled into the study conducted in our tertiary care clinic. The types of drug causing adverse reaction(s) and types of reaction(s) were recorded. The presence of atopy was assessed by skin prick tests. According to the results, the most frequently intolerated analgesic was acetyl salicylic acid (72.1%), followed by nonsteroidal anti-inflammatory drugs (68.4%) and paracetamol (15.8%). Urticaria/angioedema (52.6%) and asthmatic response (40.5%) were the most common reactions to analgesics. Compared with the general adult population of Turkey, the rate of atopy was found be higher in patients with AI and asthma (25% vs. 45%, p = 0.004) but comparable in patients with AI but no atopic disorder (25% vs. 29.2%, p> 0.05). In conclusion, subjects exhibiting intolerance to analgesics have particular features in our population; the presence of atopy in these subjects seems to be associated with the coexistent asthma rather than the drug allergy itself.