Acute generalized exanthematous pustulosis due to teicoplanin

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Unexpected anaphylaxis after completing a desensitization protocol to Oxaliplatin: successful adjuvant use of Omalizumab

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Severe maculopapular exanthema induced by regorafenib: successful desensitization and adaptation of a dosage regimen

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Practical Guidelines for Perioperative Hypersensitivity Reactions.

Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists. Therefore, hospitals should have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocol is not present in many hospitals, leading to problems with treatment, reporting of incidents, and subsequent etiological diagnosis. In this document, we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and for referral of patients with perioperative hypersensitivity reactions to allergy units. Members of the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) have created this document in collaboration with members of the Spanish Anesthesia Society (SEDAR). A practical algorithm is proposed for the etiologic diagnosis, and recommendations are provided for the management of hypersensitive patients.

Practical guidelines for perioperative hypersensitivity reactions

Perioperative hypersensitivity reactions constitute a first-line problem for anesthesiologists and allergists. Therefore, hospitals should have a consensus protocol for the diagnosis and management of these reactions. However, this kind of protocol is not present in many hospitals, leading to problems with treatment, reporting of incidents, and subsequent etiological diagnosis. In this document, we present a systematic review of the available scientific evidence and provide general guidelines for the management of acute episodes and for referral of patients with perioperative hypersensitivity reactions to allergy units. Members of the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC) have created this document in collaboration with members of the Spanish Anesthesia Society (SEDAR). A practical algorithm is proposed for the etiologic diagnosis, and recommendations are provided for the management of hypersensitive patients

Las reacciones de hipersensibilidad perioperatorias constituyen un problema de primera línea para los anestesiólogos y alergólogos, por lo que es recomendable que los hospitales tengan un protocolo de consenso para el diagnóstico y el tratamiento de estas reacciones. Sin embargo, este tipo de protocolos no está presente en muchos hospitales, lo que conlleva problemas en el tratamiento, la comunicación de incidentes y el posterior diagnóstico etiológico. Este documento ha sido creado por miembros del Comité de Alergia a Medicamentos de la Sociedad Española de Alergia e Inmunología Clínica (SEAIC) en colaboración con miembros de la Sociedad Española de Anestesia (SEDAR). Se ha realizado una revisión sistemática de la evidencia científica disponible y se proporcionan pautas generales para el manejo de episodios agudos y para la derivación de pacientes con reacciones de hipersensibilidad perioperatoria a los Servicios de Alergología. Se propone un algoritmo práctico para el diagnóstico etiológico y se brindan recomendaciones para el manejo de pacientes con reacciones alérgicas perioperatorias

Skin test-positive immediate hypersensitivity reaction to iodinated contrast media: the role of controlled challenge testing.

BACKGROUND: Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed. OBJECTIVE: We aimed to evaluate the role of controlled challenge testing in skin test-positive IHR to ICM. PATIENTS AND METHODS: We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test-negative ICM; a further 2 patients underwent computed tomography with an alternative skin test-negative ICM. No premedication was administered. RESULTS: Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test-negative ICM. The 2 patients who underwent computed tomography with an alternative skin test-negative ICM tolerated the medium. CONCLUSIONS: Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test-positive reactions in order to identify an alternative non-cross-reactive ICM.

Skin Test–Positive Immediate Hypersensitivity Reaction to Iodinated Contrast Media: The Role of Controlled Challenge Testing

Antecedentes: Aunque clásicamente las reacciones de hipersensibilidad inmediatas (RHI) a medios de contraste iodados (MCI) se han considerado no alérgicas, la publicación creciente de pruebas cutáneas y test de activación de basófilos positivos, sugieren un mecanismo alérgico específico en algunos pacientes. Se han propuesto las pruebas cutáneas como una herramienta útil para el diagnóstico, aunque su sensibilidad y valores predictivos están aún por conocer. El papel de la prueba de provocación controlada no se ha determinado. Objetivo: El objetivo fue evaluar el papel de la prueba de provocación controlada en las RHI a MCI con prueba cutánea positiva. Pacientes y Métodos: Evaluamos 106 pacientes con RHI a MCI mediante prueba cutánea con el contraste que causó la reacción. Se seleccionaron los pacientes con resultado positivo: se ampliaron las pruebas cutáneas con una serie de 8 MCI; en 5 pacientes se realizó prueba de provocación controlada con un MCI alternativo con resultado negativo en la prueba cutánea; otros dos pacientes se sometieron a una tomografía computarizada con un MCI alternativo con resultado negativo en la prueba cutánea. No se administró ninguna premedicación. Resultados: Las pruebas intradérmicas fueron positivas al MCI que causó la reacción en 11 de 106 pacientes (10.4%). Cinco de ellos toleraron la prueba de provocación controlada con un MCI alternativo con resultado negativo en la prueba cutánea. Los otros 2 pacientes a los que se les realizó una tomografía computarizada con un MCI alternativo con prueba cutánea negativa, también lo toleraron. Conclusiones: Las pruebas cutáneas son útiles para la valoración diagnóstica en las RHI alérgicas a MCI. Dado que en muchos pacientes los MCI no pueden ser evitados al ser irremplazables para algunas técnicas diagnósticas o terapéuticas, es necesario identificar un MCI alternativo para ser utilizado con seguridad en procedimientos futuros. Proponemos el uso de la prueba de provocación controlada basada en los resultados de las pruebas cutáneas para resolver esta situación en estas reacciones con prueba cutánea positiva, para poder identificar un MCI alternativo sin reactividad cruzada (AU)

Background: Immediate hypersensitivity reactions (IHR) to iodinated contrast media (ICM) have traditionally been considered nonallergic; however, the increasingly frequent reporting of positive skin test and basophil activation test results suggests a specific allergic mechanism in some patients. Skin tests have been proposed as a useful tool for diagnosis, although their sensitivity and predictive values remain to be determined. The role of controlled challenge testing has not been assessed. Objective: We aimed to evaluate the role of controlled challenge testing in skin test–positive IHR to ICM. Patients and Methods: We evaluated 106 patients with IHR to ICM by performing skin tests with the agent that caused the reaction. Patients with a positive result were selected. Skin tests were extended to a series of 8 ICMs; 5 patients underwent controlled challenge test with an alternative skin test–negative ICM; a further 2 patients underwent computed tomography with an alternative skin test–negative ICM. No premedication was administered. Results: Intradermal test results were positive to the ICM that caused the reaction in 11 out of 106 patients (10.4%). Five of the 11 patients tolerated a controlled challenge test with an alternative skin test–negative ICM. The 2 patients who underwent computed tomography with an alternative skin test–negative ICM tolerated the medium. Conclusions: Skin tests are useful for the diagnostic workup in patients with an allergic IHR to ICM. Since ICM cannot be avoided in many patients because they are irreplaceable in some diagnostic or therapeutic techniques, an alternative safe ICM should be investigated for future procedures. We propose the use of controlled challenge tests based on skin test results to address this need in skin test–positive reactions in order to identify an alternative non–cross-reactive ICM (AU)

Missense mutation Thr309Lys in the coagulation factor XII gene in a Spanish family with hereditary angioedema type III.

BACKGROUND: A new type of hereditary angioedema (type III) affecting mainly women with normal C1-inhibitor level and function has been described. Exposition to estrogens is an important precipitating factor. Recently, a missense mutation in the gene of the blood coagulation factor XII (Hageman factor) has been reported in a few families with this type of hereditary angioedema. AIM: To study a patient and her family with recurrent swelling attacks during pregnancy. METHODS: Complement factors C3 and C4 as well as C1-inhibitor level and function were determined. Genomic DNA was isolated from venous blood samples and screened for mutations in the coagulation factor XII gene. RESULTS: C3 and C4 levels as well as C1-inhibitor level and function were normal. A missense mutation Thr309Lys was identified in factor XII gene with a heterozygotic pattern. This mutation was also identified in the mother of the patient, her daughter and her son. CONCLUSION: These results support that the mentioned mutation in factor XII gene causes hereditary angioedema type III.

Anaphylaxis to oral iron salts. desensitization protocol for tolerance induction.

Allergies to iron salts are seldom reported. We studied a patient with iron-deficiency anemia who had suffered anaphylactic reactions caused by oral iron salts. An allergy study was performed using single-blind, placebo-controlled oral challenge and skin tests with various iron salts as well as excipients in commercial formulations. Oral challenges were positive for 2 of the commercial formulations of iron salts. Intradermal tests with ferrous sulphate and ferrous lactate also showed positive results. All of the cutaneous tests using the excipients were negative. A desensitization protocol was designed which enabled us to readminister ferrous sulphate, although antihistamines were necessary to guarantee good tolerance to iron salts. We report a patient with allergy to iron salts, positive skin tests, and positive controlled challenge. We highlight the desensitization protocol designed to complete the therapeutic management of the anemia.

Unilateral conjunctival chemosis as a unique symptom of nonsteroidal anti-inflammatory drug intolerance.

Patients with nonsteroidal anti-inflammatory drug (NSAID) intolerance usually have cutanous-mucosal or/and respiratory symptoms. We report the case of a patient who developed several episodes of left-eye conjunctivitis, manifested as conjunctival chemosis, with no other symptoms, after taking metamizole and other unidentified NSAIDs. We performed both a single blind placebo-controlled oral challenge test and conjunctival challenge test with different NSAIDs. The single blind placebo-controlled oral challenge was positive to ketoprofen and diclofenac. The conjunctival challenge with diclofenac and flurbiprofen was negative. The patient tolerated celecoxib and nabumetone. We believe this to be an exceptional case of NSAID intolerance as conjunctival chemosis has not hitherto been included in any of the classic types of pseudoallergic reactions.

Diagnosis and management of hypersensitivity reactions caused by oxaliplatin.

Hypersensitivity reactions to oxaliplatin have been increasing since its introduction at the end of the 1990s, but allergy tests with antineoplastic drugs are rarely used to aid diagnosis. We describe 5 cases in which hypersensitivity reactions to oxaliplatin after several courses of chemotherapy were managed by allergy testing and desensitization. Skin prick tests were negative at 1 mg/mL in all patients, positive at 10 mg/mL in 2 tested patients, and negative in 10 control subjects. Intradermal tests were positive and not irritant at 0.01 to 0.001 mg/mL concentrations. A desensitization protocol with increasing concentrations and flow rates was successfully completed in all patients. We conclude that prick and intradermal skin tests are useful in the diagnosis of hypersensitivity reactions to oxaliplatin and that the desensitization protocol performed avoided discontinuation of chemotherapy in all patients.