Reproducibility of delayed-type reactions to betalactams.

BACKGROUND: Delayed reactions with betalactam antibiotics are a very common reason for consultation and a matter of numerous publications. OBJECTIVE: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge. To analyse the characteristics of people showing this type of reaction. METHODS: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. RESULTS: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. CONCLUSIONS: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams.

Reproducibility of delayed-type reactions to betalactams

Background: Delayed reactions with betalactam antibiotics are a very common reason for consultationand a matter of numerous publications. Objective: To demonstrate that delayed reactions occurring during treatment with betalactam antibiotics are not reproduced in a high percentage of the patients, when making drug challenge.To analyse the characteristics of people showing this type of reaction. Methods: We included in our study all the patients who came to our Allergy Department during one year (2004), with a clinical history of delayed reaction (> 72h) to betalactams. Skin prick tests (SPT), intradermal tests (IT) and patch tests were carried out, followed by simple blind placebo controlled drug challenge (SBPCDC) at hospital and home treatment with betalactams. Results: We studied 23 patients (12 men and 11 women), average age 23.4 years old. SPT and patch test were negative in all patients. Only one patient showed positive IT tests, and allergic reaction was only reproduced in two patients; 76 % tolerated the drug involved in supposed allergy. Conclusions: Simple blind oral challenge with implicated drug followed by home treatment is required for a conclusive diagnosis of allergy in patients with delayed reactions to betalactams

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[Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs]. / Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos.

INTRODUCTION: Hypersensitive reactions to analgesics in the general population are less than 1%. Previous studies have demonstrated that cyclooxigenase 2 (COX-2) inhibitors are an efficient alternative in patients with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance. The aim of our study is to test the tolerance to celecoxib and meloxicam in patients with NSAIDs intolerance, upto dosages higher than those used in previous studies. MATERIAL AND METHODS: The subjects of the study were 38 NSAID-sensitive patients from September 2004 to June 2005. The diagnosis of intolerance to NSAIDs was carried out by means of single-blind placebo-controlled oral challenge with aspirin. We performed single-blind placebo controlled oral challenge tests with celecoxib (accumulated dose of 400 mg) and meloxicam (accumulated dose of 15 mg). RESULTS: There was only one reaction with celecoxib (97.3%) which was generalised urticaria after the dose of 400 mg accumulated, it should be pointed out that this patient tolerated perfectly the dose of 200 mg. For meloxicam, we found 100% tolerance at a dosage of 15 mg, including the patient who showed a reaction to the celecoxib. CONCLUSION: We consider that there are patients with tolerance to low dosages of COX-2 inhibitors who show a reaction on increasing the administered dosage, which means that their tolerance should be taken into account and checked in the long term.

Tolerancia a celecoxib y meloxicam en pacientes con intolerancia a analgésicos no esteroideos / Tolerance to celecoxib and meloxicam in patients with intolerance to nonsteroidal anti-inflammatory drugs

Introducción: Las reacciones de hipersensibilidad a analgésicos en la población general son menores del 1%. En estudios previos se ha comprobado que los inhibidores de la ciclo-oxigenasa 2 (COX-2) son una alternativa eficaz en pacientes con intolerancia a antiinflamatorios no esteroideos (AINES). El objetivo de nuestro estudio es comprobar la tolerancia en pacientes diagnosticados de intolerancia a AINES a celecoxib y meloxicam, hasta dosis superiores a las utilizadas en estudios previos. Material y métodos: Los sujetos del estudio son 38 pacientes diagnosticados en nuestro Servicio de Alergia del Hospital Clínico San Carlos de intolerancia a AINES desde el mes de septiembre de 2004 a junio de 2005. El diagnóstico de intolerancia a AINES se había realizado mediante POSCCP (provocación oral simple ciego controlada con placebo) con AAS según protocolo de nuestro servicio. Se llevaron a cabo POSCCP con celecoxib hasta una dosis acumulada de 400 mg y meloxicam hasta una dosis acumulada de 15 mg. Resultados: Sólo se presentó una reacción con celecoxib que consistió en urticaria generalizada tras la toma de 400 mg acumulados. Este paciente había tolerado previamente una dosis de 200 mg. Con respecto al meloxicam, encontramos una tolerancia del 100%, incluyendo el paciente que presentó reacción con celecoxib. Conclusiones: Consideramos que al existir pacientes con tolerancia a dosis bajas de los inhibidores de la COX-2 que presentan reacción al elevar la dosis administrada, se debería comprobar la tolerancia de estos fármacos a largo plazo

Introduction: Hypersensitive reactions to analgesics in the general population are less than 1%. Previous studies have demonstrated that cyclooxigenase 2 (COX-2) inhibitors are an efficient alternative in patients with non-steroidal anti-inflammatory drugs (NSAIDs) intolerance.The aim of our study is to test the tolerance to celecoxib andmeloxicam in patients with NSAIDs intolerance, upto dosages higherthan those used in previous studies. Material and methods: The subjects of the study were 38 NSAID-sensitive patients from September 2004 to June 2005. The diagnosis of intolerance to NSAIDs was carried out by means of single-blind placebo-controlled oral challenge with aspirin. We performed single-blind placebo controlled oral challenge tests with celecoxib (accumulated dose of 400 mg) and meloxicam (accumulated dose of 15 mg). Results: There was only one reaction with celecoxib (97.3%) which was generalised urticaria after the dose of 400 mg accumulated, it should be pointed out that this patient tolerated perfectly the dose of 200 mg. For meloxicam, we found 100% tolerance at a dosage of 15 mg, including the patient who showed a reaction to the celecoxib. Conclusion: We consider that there are patients with tolerance to low dosages of COX-2 inhibitors who show a reaction on increasing the administered dosage, which means that their tolerance should be taken into account and checked in the long term

Occupational asthma due to acrylates in a graphic arts worker.

BACKGROUND: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. MATERIAL AND METHODS: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. RESULTS: The PEF improved on weekends and sick leave. The challenge test provoked a late asthmatic response and the non-specific bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount.

Occupational asthma due to acrylates in a graphic arts worker / Asma ocupacional por acrilatos en un trabajador de artes gráficas

Background: Acrylates are used in a wide variety of products such as solvents, adhesives, paints, printing ink, soft contact lenses, porcelain nails, and methacrylates (used by dentists and orthopedists). Currently there are various types of acrylic compounds: acrylates, cyanoacrylates (such as tissue adhesives and home glues), and methacrylates (prostheses and dental and orthopedic fillings). The sensitization mechanism is unknown, but the allergy is believed to be due to a non-IgE mediated phenomenon, since a late asthmatic response occurs. Various cases of acrylate-induced asthma have been reported, especially in dentists and persons using glues or paints containing this substance. Material and methods: We present the case of a 52-year-old man who had been working in graphic arts for the previous 7 years. For the previous 2 years he had experienced persistent cough with a sensation of drowning, dyspnea that increased with moderate exertion, and nasal obstruction despite continuous treatment. The symptoms first appeared after an episode of acute respiratory difficulty associated with weight loss, pulmonary infiltrates, and eosinophilia. Peak expiratory flow (PEF) was measured during work and sick leave, and specific bronchial challenge with acrylates was performed in a bronchial chamber. Results: The PEF improved on weekends and sick leave. The challenge test provoked a late astmatic response and the non-specifc bronchial hyperreactivity increased after the test. As well in the sputum samples there was a increase of eosinophil amount

Antecedentes: Los acrilatos se usan en una amplia variedad de productos, como solventes, adhesivos, pinturas, tinta de imprenta, lentes de contacto blandas y uñas de porcelana, mientras que los metacrilatos los usan dentistas y ortopedas. Hay varios tipos de compuestos acrílicos: acrilatos, cianoacrilatos (como adhesivos de tejidos y pegamentos de uso doméstico), así como de metacrilatos usados en prótesis dentales y rellenos ortopédicos. Los mecanismos de sensibilización se desconocen, pero se piensa que la reacción alérgica no está mediada por IgE, ya que la reacción asmática se produce tardíamente. Hay publicados varios casos de asma inducida por acrilato, especialmente en dentistas y personas que usan colas o pinturas que contienen esas sustancias. Material y métodos: Se presenta el caso de un varón de 52 años de edad que había trabajado en artes gráficas en los últimos 7 años. En los dos últimos años había presentado tos persistente con sensación de ahogo, disnea que aumentaba con el ejercicio moderado y obstrucción nasal, a pesar del tratamiento continuado. Los síntomas aparecieron primero tras un episodio agudo de dificultad respiratoria asociada con pérdida de peso, infiltrados pulmonares y eosinofilia. El flujo espiratorio punta (PEF) se midió durante el trabajo y los días de baja laboral. Se llevó a cabo prueba de provocación con acrilatos en cámara bronquial. Resultados: El PEF mejoró en los fines de semana y los días de baja laboral. El test de provocación dio lugar a una crisis de asma tardía. Después de la prueba, aumentó la hiperreactividad bronquial no específica. Al mismo tiempo, en las muestras de esputo se constató un aumento del contenido en eosinófilos

Flare up to betalactams.

BACKGROUND: The flare up phenomenon has most frequently been described with nickel. Not many cases of flare up to drugs have reported in the literature, however we have reported it with different medications. METHODS AND RESULTS: A 31-year-old woman developed an adverse reaction with an antibiotic during her childhood. Prick test with penicillin (100,000 IU/ml), penicilloyl polylysine (PPL), minor determinant mixture (MDM), amoxicillin (200 mg/ml), ampicillin (200 mg/ml) and cephalotin (200 mg/ml), and intradermal test to the same substances diluted in saline were all negative immediately. We performed an oral challenge test with 500 mg of amoxicillin. Twelve hours later, the intradermal test to PPL and MDM became positive (PPL 10 x 10 mm, MDM 8 x 7 mm). All patch tests were positive after 72 hours with erythema, vesicles and infiltration and the patient also had exanthema with pruritus on her entire body. CONCLUSIONS: We present one patient with delayed allergic reaction caused by amoxicillin and penicillin, that we all know as Flare up. We suggest that this phenomenon of Flare up occurs by a Type IV mechanism mediated by T-cells without participation of IgE antibodies. The betalactam hypersensitivity mechanism which has usually been described is an IgE mediated reaction, but there are other not very well known mechanisms that are responsible for the delayed reactions.

Flare up to betalactams

Background: The flare up phenomenon has most frequently been described with nickel. Not many cases of flare up to drugs have reported in the literature, however we have reported it with different medications. Methods and results: A 31-year-old woman developed an adverse reaction with an antibiotic during her childhood. Prick test with penicillin (100,000 IU/ml), penicilloyl polylysine (PPL), minor determinant mixture (MDM), amoxicillin (200 mg/ml), ampicillin (200 mg/ml) and cephalotin (200 mg/ml), and intradermal test to the same substances diluted in saline were all negative immediately. We performed an oral challenge test with 500 mg of amoxicillin. Twelve hours later, the intradermal test to PPL and MDM became positive (PPL 10 x 10 mm, MDM 8 x 7 mm). All patch tests were positive after 72 hours with erythema, vesicles and infiltration and the patient also had exanthema with pruritus on her entire body. Conclusions: We present one patient with delayed allergic reaction caused by amoxicillin and penicillin, that we all know as Flare up. We suggest that this phenomenon of Flare up occurs by a Type IV mechanism mediated by T-cells without participation of IgE antibodies. The betalactam hypersensitivity mechanism which has usually been described is an IgE mediated reaction, but there are other not very well known mechanisms that are responsible for the delayed reactions

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