Presentation entitled "Drug Allergy: what have we learned from immunogenetics?", updated and published in Portuguese as an open access full-text "Santos N, Cernadas J. Imunogenética das reacções alérgicas a fármacos. Rev Port Imunoalergologia 2013;23(4):247-258."
about drugs that are causing hypersensitivity reaction in human body systems. it include aspirin,sulfonamide,pencillin,their symptoms,dianosis,prevention etac included
Presentation entitled "Drug Allergy: what have we learned from immunogenetics?", updated and published in Portuguese as an open access full-text "Santos N, Cernadas J. Imunogenética das reacções alérgicas a fármacos. Rev Port Imunoalergologia 2013;23(4):247-258."
about drugs that are causing hypersensitivity reaction in human body systems. it include aspirin,sulfonamide,pencillin,their symptoms,dianosis,prevention etac included
• Recognize that the majority of reported penicillin allergies are
not confirmed upon testing and expose patients to undue
harm
• Understand when diagnostic testing, including skin testing, is
indicated to confirm an antimicrobial allergy
• Employ strategies to determine if cephalosporins can be used
in patients with reported penicillin allergies.
Drug allergy is the term for a group of symptoms caused by an allergic reaction. An allergic reaction occurs when your immune system mistakes the drug for a harmful substance and mounts an inflammatory response that actually harms rather than protects you. Any medication — over-the-counter, prescription or herbal — is capable of inducing a drug allergy. However, a drug allergy is more likely with certain medications
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
Immunotherapy in children SCIT or SLIT. Dra. Desirée Larenas WISC Dec2014 ...Juan Carlos Ivancevich
Symposium: Immunotherapy in Latin America - WISC 2014- Rio de Janeiro
Symposium 5: Latin American Society of Allergy and Immunology (SLAAI) Symposium: Immunotherapy in Latin America Sala 1 & 2 (Sul America)
Drug hypersensitivity results from interactions between a pharmacologic agent and the human immune system.
Immune-mediated drug hypersensitivity reactions typically pose a predictable, more serious health risk with re-exposure to a drug
• Recognize that the majority of reported penicillin allergies are
not confirmed upon testing and expose patients to undue
harm
• Understand when diagnostic testing, including skin testing, is
indicated to confirm an antimicrobial allergy
• Employ strategies to determine if cephalosporins can be used
in patients with reported penicillin allergies.
Drug allergy is the term for a group of symptoms caused by an allergic reaction. An allergic reaction occurs when your immune system mistakes the drug for a harmful substance and mounts an inflammatory response that actually harms rather than protects you. Any medication — over-the-counter, prescription or herbal — is capable of inducing a drug allergy. However, a drug allergy is more likely with certain medications
Drug reaction with eosinophilia and systemic symptoms & acute generalized exanthematous pustulosis 2019
Presented by Nattasasi Suchamalawong, MD.
November 15, 2019
Immunotherapy in children SCIT or SLIT. Dra. Desirée Larenas WISC Dec2014 ...Juan Carlos Ivancevich
Symposium: Immunotherapy in Latin America - WISC 2014- Rio de Janeiro
Symposium 5: Latin American Society of Allergy and Immunology (SLAAI) Symposium: Immunotherapy in Latin America Sala 1 & 2 (Sul America)
Drug hypersensitivity results from interactions between a pharmacologic agent and the human immune system.
Immune-mediated drug hypersensitivity reactions typically pose a predictable, more serious health risk with re-exposure to a drug
Drug allergy is the non-immune-mediated reaction that is often caused by the intolerance of drug . To explain about the allergic reaction and to help people avoid a major hard you can easily take the help of the Drug allergy PPT templates online. More info: http://bit.ly/1fiS4nQ
Sesión Académica del CRAIC: Hipersensibilidad a fármacos en Pediatría.Dra. Rosa IvettGuzmán AvilánResidente de Primer año
Dra. med. Gabriela Galindo Rodríguez Profesor Asesor
A case series on Ocular Manifestations in Stevens Johnson Syndrome and Toxic ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Allergic disorders are on rise with increase in urbanization, improved personal hygiene & more people migrating in search of jobs, better opportunities. Diagnosis of allergy can aid the clinician is appropriate counselling of the patient for avoidance of specific allergens & if required prescribe appropriate immunotherapy.
Food allergy in adults-the experience of a center in the north of portugalNatacha Santos
Couto M, Coimbra A, Silva D, Santos N, Pereira A, Plácido JL. Food allergy in adults: the experience of a center in the north of Portugal. Clinical and Translational Allergy 2013, 3(Suppl 3):66.
Efficacy and safety of immunomodulators in pediatric age - Slideset by Profes...WAidid
«The first cause of recurrent infections in children is... childhood itself.» (J. Gary Wheeler)
Is it possibe to treat and prevent recurrent respiratory infections (RTIs) in pediatric age? Some studies have shown that immunostimulants/immunomodulators can reduce and prevent RTIs in children.
To learn more please visit www.waidid.org
Childhood demyelinating syndromes
In the past decade, the number of studies related to demyelinating diseases in children has exponentially increased. Demyelinating disease in children may be monophasic or chronic. Typical monophasic disorders in children are acute disseminated encephalomyelitis and clinically isolated syndromes, including optic neuritis and transverse myelitis. However, some cases of acute disseminated encephalomyelitis or clinically isolated syndrome progress to become chronic disorders, including multiple sclerosis and neuromyelitis optica. This review summarizes the current knowledge on monophasic and chronic demyelinating disorders in children, focusing on an approach to diagnosis and management.
Presented at the joint International Eczema Council and National Alopecia Areata Foundation Symposium, "Atopic Dermatitis and Alopecia Areata: Comparison and Contrast”, held during the 2019 Annual American Academy of Dermatology meeting in Washington, DC to explore the similarities and differences between these two common but complex skin diseases and the implications from bench to bedside.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
1. WHAT YOU SHOULD HAVE READ BUT….2012
drug allergy
Attilio Boner
University of
Verona, Italy
2. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
Background Proven IgE or T-cell mediated
drug hypersensitivity reactions (DHRs) seem
less common in children compared with adults.
However, this has never been proved by data.
Objective To determine and compare
proven DHR prevalence in children and adults.
3. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
(Drug Allergy and Hypersensitivity
Database) cohort. % of patients belonged to the
A/A group
Children with proven drug 100 –
hypersensitivity reactions (DHRs) 90 –
compared with adults.
80 –
4 groups:
74.5%
70 –
- index reaction and test during
60 –
childhood (C/C);
50 –
- index reaction at childhood and test
at adulthood (C/A); 40 –
- index reactions at childhood and 30 –
adulthood and test at adulthood (CA/A); 20 –
- index reaction and test at adulthood
10 –
(A/A).
0
3275 patients.
4. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
Prevalence of positive tests.
25 – p<0.0001
p=0.003
20 – 22.1%
15 –
15.2%
10 – 16.5%
10.6% 10.6%
05 –
0
All C/C C/A CA/A A/A
Tested classes
5. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
Prevalence of positive tests.
25 – p<0.0001
p=0.003
20 – 22.1%
15 –
15.2%
10 – 16.5%
10.6% 10.6%
05 –
Significant differences were found for
0 maculopapular exanthemas only, and not for
All C/C C/A CA/A A/A
urticaria/angioedema and anaphylaxis.
Tested classes
6. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
Prevalence of positive tests.
25 – p<0.0001
p=0.003
20 – 22.1%
15 –
15.2%
10 – 16.5%
10.6% 10.6%
05 –
The difference was mainly observed
0 with β-lactams andC/A for NSAIDs.
not CA/A A/A
All C/C
Tested classes
7. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
1) When the first reaction occurred during
childhood, the prevalence rate of positive
tested class was similar whether the test was during childhood
(10.6%) or adulthood (10.6%); thus, one could argue that drug
allergy in childhood does not resolve with time.
2) Finally, the rate of positive tested classes was higher when
several reactions to the same drug class were observed
(22%).
8. Results of drug hypersensitivity evaluations
in a large group of children and adults.
Rubio, Clin Exp Allergy 2012;42:123
3) In children, exanthems during antibiotic courses can
be difficult to assess. Maculopapular eruptions that are
not pruritic occur frequently, as has been observed in 3–7%
of children taking ampicillin in one study. They emerge during
antibiotic treatment and rarely after. These exanthems are
very unlikely to be allergic and their mechanisms are not well
studied.
4) Furthermore, the immune response that a patient develops
for a viral infection can alter the immune response
to an antibiotic, resulting in an allergic-like reaction
specifically to that antibiotic, which is highly unlikely to recur.
Caubet, JACI 2011;127:218;
Pichichero, Pediatrics 2005;115:1048.
10. Recurrence and outcomes of Steven-Jhonson Syndrome
and Toxic Epidermal Necrolysis in children
Finkelstein Pediatrics 2011;128:723
Stevens-Johnson Syndrome (SJS) and
toxic epidermal necrolysis (TEN) are
rare, life-threatening conditions that represent
different intensities along a spectrum
of severe cutaneous adverse reactions
to drug therapy.
Both conditions are associated with
significant morbidity and mortality
(up to 5% in SJS and 20% in TEN in adults).
11. Recurrence and outcomes of Steven-Jhonson Syndrome
and Toxic Epidermal Necrolysis in children
Finkelstein Pediatrics 2011;128:723
SJS is defined as epidermal detachment
of 10% body surface area;
TEN as 30% of Body Surface Area;
Cases with skin involvement between 10% and 30%
are classified as SJS/TEN overlap.
12. Recurrence and outcomes of Steven-Jhonson Syndrome
and Toxic Epidermal Necrolysis in children
Finkelstein Pediatrics 2011;128:723
60 – % cases due to
53%
50 –
55 cases of 40 –
SJS 29/55
(n=47), 30 –
TEN (n=5) or
22%
SJS/TEN 20 –
overlap syndrome
(n=3). 10 – 9%
12/55
5/55
0
Drugs Acute Mycoplasma Herpes simplex
Pneumoniae virus
infection.
13. Recurrence and outcomes of Steven-Jhonson Syndrome
and Toxic Epidermal Necrolysis in children
Finkelstein Pediatrics 2011;128:723
60 – % cases due to
53%
50 –
55 cases of drugs
Antiepileptic
SJSwere the most 40 – 29/55
common agents
(n=47), 30 –
(n=16), followed by
TEN (n=5) or
sulfonamide 20 –
22%
SJS/TEN
antibiotics (n=7) and
overlap syndrome
chemotherapy drugs –
(n=3). 10 9%
(n=2). 12/55
5/55
0
Drugs Acute Mycoplasma Herpes simplex
Pneumoniae virus
infection.
14. Recurrence and outcomes of Steven-Jhonson Syndrome
and Toxic Epidermal Necrolysis in children
Finkelstein Pediatrics 2011;128:723
10 children (18%) had recurrence of SJS up to 7 years
after the index 60 – % cases due to
episode,3 experienced multiple recurrences.
53%
50 –
55 cases of drugs
Antiepileptic
SJSwere the most 40 – 29/55
common agents
(n=47), 30 –
(n=16), followed by
TEN (n=5) or
sulfonamide 20 –
22%
SJS/TEN
antibiotics (n=7) and
overlap syndrome
chemotherapy drugs –
(n=3). 10 9%
(n=2). 12/55
5/55
0
Drugs Acute Mycoplasma Herpes simplex
Pneumoniae virus
infection.
17. Diagnosis of drug hypersensitivity in children and
adolescents: Discrepancy between physician-based
assessment and results of testing
Seitz Pediat Allergy Immunol 2011;22:405
Diagnosis of drug
hypersensitivity is often
based on history alone.
To confirm or rule out drug Drug hypersensitivity was
hypersensitivity, skin excluded in 40 patients
testing, in vitro studies, and by tolerated oral
challenge tests are challenge tests with the
necessary. incriminated drug.
43 children and adolescents
with a history of immediate
or delayed hypersensitivity
symptoms in temporal
18. Diagnosis of drug hypersensitivity in children and
adolescents: Discrepancy between physician-based
assessment and results of testing
Seitz Pediat Allergy Immunol 2011;22:405
Diagnosis of drug
Allergologic testing in
hypersensitivity is often
cases of suspected
based on history alone.
To drug hypersensitivity
confirm or rule out drug Drug hypersensitivity was
is of importance both
hypersensitivity, skin testing, excluded in 40 patients
in vitro studies, a correct
to establish and challenge
by tolerated oral
tests diagnosis and to
are necessary. challenge tests with the
prevent unjustified
43 withholding of a drug
children and adolescents incriminated drug.
with a history of immediate
or class of drugs.
or delayed hypersensitivity
symptoms in temporal
relation to drug treatment.
20. The diagnostic value of basophil activation test in
patients with an immediate hypersensitivity reaction
to radiocontrast media.
Pinnobphun Ann Allergy Asthma Immunol 2011;106:387
Background
No available test diagnoses allergic reactions to radiocontrast
media (RCM). The basophil activation test (BAT) has been
introduced for the diagnosis of both IgE and
non-IgE–dependent mast cell degranulation, but its value
to diagnose immediate RCM reactions is still unknown.
Objective
This study aims to evaluate the diagnostic value of BAT in
immediate RCM hypersensitivity.
21. The diagnostic value of basophil activation test in
patients with an immediate hypersensitivity reaction
to radiocontrast media.
Pinnobphun Ann Allergy Asthma Immunol 2011;106:387
% activated basophil
26 patients with immediate 20 –
allergic reactions to 19.2%
radiocontrast media (RCM). 15 –
p=0.001
43 healthy volunteers.
10 –
Whole blood was incubated
with the responsible RCM. 05 –
% activated (CD63+/CCR3+) 3.73%
00
basophils were analyzed by Patients with a Normal
flow cytometry. history of immediate controls
RCM reactions
22. The diagnostic value of basophil activation test in
patients with an immediate hypersensitivity reaction
to radiocontrast media.
Pinnobphun Ann Allergy Asthma Immunol 2011;106:387
% activated basophil
26 patients with immediate 20 –
allergic reactions to
Our study demonstrated 19.2%
radiocontrast media BAT
the potential of (RCM). 15 –
p=0.001
as a diagnostic tool
43 healthy volunteers.
for an immediate RCM 10 –
hypersensitivity,
Whole blood was incubated
particularly as a
with the responsible RCM. 05 –
confirmation test.
% activated (CD63+/CCR3+) 3.73%
00
basophils were analyzed by Patients with a Normal
flow cytometry. history of immediate controls
RCM reactions
24. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
Immediate IgE-mediated allergic reactions to corticosteroids
are rather uncommon, whereas causative agents usually involve
the native steroid molecule or a pharmaceutical excipient, in
most cases as succinate ester bound to methyl-prednisolone or
hydrocortisone;
We here report two cases of immediate reaction to
methyl-prednisolone, attributed to milk allergen contamination.
25. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
1) A 9 yrs old boy with severe persistent cow’s milk allergy
(CMA) was seen for asthma exacerbation;
2) The boy was administered 40 mg of methyl-prednisolone by
intravenous injection;
3) Paradoxically, wheezing deteriorated;
4) The boy was given another course of the same medication on
assumption of clinical under-responsiveness;
5) Within a few minutes the patient acutely collapsed.
26. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
a) Another patient, a 7-year-old boy with severe CMA was
similarly treated with intravenous administration of 40 mg
methyl-prednisolone;
b) The therapeutic intervention resulted in a full-blown
anaphylactic reaction;
c) Both children were evaluated within the next 6 months for
assumed IgE-mediated reactivity to methyl-prednisolone.
27. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
Skin testing results in both patients with acute
reaction to lactose-containing succinylated
methyl-prednisolone
28. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
Sensitization to theresultssteroid molecule andwith acute
Skin testing native in both patients to the succinate
reaction to lactose-containing succinylated
ester was ruled out by negative skin tests, while both patients exhibited
positive skin response exclusively to lactose-containing preparations.
methyl-prednisolone
29. Cow’s milk allergy as a cause of anaphylaxis to systemic
corticosteroids
Savvatianos, Siragakis, Allergy 2011;66:983
milk
Subsequent drug provocation tests were negative in both patients
Skin a full therapeuticboth patients with acute reaction
for testing results in dose (125 mg) of non-lactose
to lactose-containing succinylated methyl-prednisolone
containing, otherwise identical to the one that elicited the
reaction, succinylated methyl-prednisolone preparation
(Solu-Medrol 125 mg, Pfizer)
31. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
• Like penicillins, cephalosporins can cause nonimmediate reactions
(occurring >1 hour and within 7 days after the last administration).
• The main nonimmediate reactions are
maculopapular or morbilliform rashes and
delayed-appearing urticaria/angioedema.
• There are studies suggesting that either
delayed-reading intradermal tests or patch tests,
or both can be an effective way of diagnosing a delayed
hypersensitivity.
32. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
• In the present study*, according to the diagnostic protocol
devised by the European Network for Drug Allergy, subjects with
histories of nonimmediate reactions to cephalosporins were
assessed by using both patch tests and delayed-reading (after >48
hours) skin tests and, in case of negative responses, by provocation
tests in an attempt to clarify the pathogenic mechanism involved.
• Skin prick and intradermal tests using penicilloyl-polylysine, minor
determinant mixture, and benzylpenicillin, as previously described.
In the second evaluation 2 days later, we used ampicillin and
amoxicillin at concentrations of 1 and 20 mg/mL, as well as the
suspect cephalosporins at a concentration of 2 mg/mL and any other
suspect penicillins at concentrations of 1 and 20 mg/mL.
*Romano A, Allergy 2004;39:1153-60
33. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
Positive controls for skin prick and intradermal tests were
performed with histamine (at 10 and 1 mg/mL, respectively). As a
negative control for skin prick and intradermal tests, normal saline
was used.
We used the suspect aminocephalosporins
(cephalexin, cefaclor, and cefatrizine) at concentrations of 2 and 20
mg/mL.
Readings of late reactions to intradermal tests were done after
48 and 72 hours; any infiltrated erythema with a diameter larger
than 5 mm was considered a positive reaction.
Patch tests with benzylpenicillin, ampicillin, and amoxicillin, as well
as with suspect cephalosporins and any other suspect penicillins
(5% in petrolatum), as previously described. Readings were made 15
34. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
Subjects with negative results in all of the above tests or who
displayed a doubtful response underwent challenges with the
suspect cephalosporin concerned: cephalexin (1 g), cefaclor
(500mg), cefixime (400 mg), ceftibuten (400 mg), cefatrizine (500
mg), cefprozil (500 mg), cefpodoxime (200 mg), and cefuroxime
axetil (500 mg) administered orally or
ceftriaxone, ceftazidime, cefotaxime, cefamandole, cefazolin, cefon
icid, and cefepime (1 g) administered intramuscularly.
We administered an initial dose of one hundredth of the
therapeutic one.
In patients with negative results, 1 week later, we administered a
dose of one tenth and, if the result was again negative, a full dose
after another week, as previously described.
35. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
Subjects with negative results in all of the above tests or who
displayed a doubtful response underwent challenges with the
suspect cephalosporin concerned: cephalexin (1 g), cefaclor
(500mg), cefixime (400 mg), ceftibuten (400 mg), cefatrizine (500
Each patient was carefully monitored during
mg), cefprozil (500 mg), cefpodoxime (200 mg), and cefuroxime
axetil challenges until administered
(500 mg) 4 hours after the orally or
ceftriaxone, administration of thecefamandole, cefazolin, cefon
ceftazidime, cefotaxime, dose; complete
icid, and equipment g) administered intramuscularly.
cefepime (1 for cardiopulmonary resuscitation
We administered was initial dose of one hundredth of the
an immediately available.
therapeutic one.
In patients with negative results, 1 week later, we administered a
dose of one tenth and, if the result was again negative, a full dose
after another week, as previously described.
36. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
105 subjects with 3 subjects showed both positive
histories of patch test and positive delayed
nonimmediate intradermal test results to the
reactions to culprit cephalosporins,
cephalosporins whereas
Patients had a total 2 presented only a delayed
of 144 reactive positive intradermal test result to
episodes these cephalosporins
37. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
105 subjects with 1 patient experienced a
histories of maculopapular rash with diffuse
nonimmediate angioedema during cephalexin
reactions to therapy, had negative patch test
cephalosporins results, and displayed a doubtful
response (an infiltrated erythema
Patients had a total with a diameter of 3 mm) to the
of 144 reactive delayed-reading intradermal test
episodes with cephalexin at 2 mg/mL.
38. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
Another patient a local
reaction (infiltrated
105 subjects witha diameter
erythema with 1 patient experienced a
histories oflasting 4 days) 3
of 11 cm maculopapular rash with diffuse
nonimmediate the second
hours after angioedema during cephalexin
reactions to
intramuscular injection of therapy, had negative patch test
cephalosporins
cefodizime. She presented results, and displayed a doubtful
response (an infiltrated erythema
Patients had aresponses to
immediate total
with a diameter of 3 mm) to the
intradermal tests
of 144 reactive
with cefodizime, as well delayed-reading intradermal test
episodes with cephalexin at 2 mg/mL.
as patch test
39. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
• In the present study most delayed skin manifestations in temporal
correlation with cephalosporin treatments did not show a
sensitization on intradermal skin tests nor could they be reproduced
in a provocation test. Thus allergy alone does not seem to be a
sufficient explanation for them.
• It is interesting to note that the mean time for resolution of
generalized skin reactions was significantly longer in the patients
with sensitization than in the patients without sensitization (13.6 vs
3.31 days).
40. Diagnosing nonimmediate reactions to cephalosporins
Romano, JACI 2012;129:1166
• Patch tests and delayed-reading intradermal tests are useful tools
in evaluating nonimmediate reactions to ß-lactams, particularly
maculopapular rashes.
• Concentration of 20 mg/mL used for intradermal tests with
aminocephalosporins might reduce the number of subjects with
false-negative results at the concentration of 2 mg/mL.
• In conclusion, intradermal tests are useful tools in identifying
the cephalosporins responsible for nonimmediate reactions.
However, considering the results of the present study, patch
testing is not indicated in subjects with mild nonimmediate
reactions to cephalosporins, such as maculopapular and urticarial
rashes.
41. Nonimmediate drug allergy: diagnostic benefit of skin
testing and practical approach. Editorial
Schnyder, JACI 2012;129:1170
• There is currently no established gold standard for the diagnosis
of a delayed-type allergy.
• Romano et al* used weekly challenges with first one hundredth and
then one tenth and finally one single therapeutic daily dose.
• However, it is well documented that some nonimmediate reactions
appear only after a treatment of several days at full therapeutic
dosage.
•Furthermore, cofactors, such as concomitant viral infections, are
considered important, and these are normally not present during
challenge tests.
•Thus only a positive test result is conclusive, and even challenge
tests are not an unequivocal gold standard.
*Romano A, J Allergy Clin Immunol 2012;129:1166
42. Nonimmediate drug allergy: diagnostic benefit of skin
testing and practical approach. Editorial
Schnyder, JACI 2012;129:1170
• Sensitivity requires not only the detection of patients with drug
hypersensitivity in spite of negative skin test results (false-negative
results) but also the number of patients with positive skin test
results who really have drug hypersensitivity (true-positive results).
• The negative predictive value (or negative posttest probability)
stands for the probability that a patient with a negative test result
has no allergy.
• However, the predictive value is not only dependent on test
accuracy but also on the pretest probability. Pretest probability
stands for the probability that a patient has an allergy before
testing. It is influenced inter alia by patient selection.
43. Nonimmediate drug allergy: diagnostic benefit of skin
testing and practical approach. Editorial
Schnyder, JACI 2012;129:1170
• Sensitivity requires not only the detection of patients with drug
hypersensitivity in spite of negative skin test results (false-negative
results) but also the number of patients with positive skin test
results who really have drug hypersensitivity (true-positive results).
• The negative predictive value (or negative posttest probability)
stands for the probability that a patient with a negative test result
has no allergy.
• However, the predictive value is not only dependent on test
A low negative predictive value might be
accuracy but also on the pretest probability. Pretest probability
stands for the probability that alow pretest an allergy before
entirely due to a very patient has probability
testing. It is influenced inter alia by patient selection.
44. Nonimmediate drug allergy: diagnostic benefit of skin
testing and practical approach. Editorial
Schnyder, JACI 2012;129:1170
Avoiding further use of the incriminated drug without performing a
challenge test might be a pragmatic and widely used approach,
especially if the incriminated drug is easy to replace.
When the incriminated drug (or drug class) is difficult to replace
and there is an urgent need for this treatment, a stepwise (graded)
challenge might be an option, hoping to eliminate those reactions
that are due to strong sensitizations.
Altogether, the situation is not yet satisfying, and improvements in
in vivo and in vitro evaluations of these reactions are urgently
needed.
47. Response to a selective COX-2 inhibitor in patients with
urticaria/angioedema induced by nonsteroidal
anti-inflammatory drugs. Doña, Allergy 2011;66:1428
% patients intolerant to etoricoxib
252 patients with urticaria 30 –
and/or angioedema caused
by hypersensitivity owing
to cross-intolerance to
25%
20 –
NSAIDs;
(A) patients with
intolerance to paracetamol; 10 –
(B) patients with tolerance
to paracetamol. 6%
0
GROUP A GROUP B
48. Response to a selective COX-2 inhibitor in patients with
urticaria/angioedema induced by nonsteroidal
anti-inflammatory drugs. Doña, Allergy 2011;66:1428
% patients intolerant to etoricoxib
252 Selective with urticaria
patients COX-2 30 –
and/or angioedemabe
inhibitors may caused
by hypersensitivity owing
unsafe in subjects
to with urticaria and/or
cross-intolerance to
25%
20 –
angioedema caused by
NSAIDs;
hypersensitivity
(A) patientsto NSAIDs
reactions with
intolerance to paracetamol; 10 –
with cross-intolerance
to paracetamol.
(B) patients with tolerance
to paracetamol. 6%
0
GROUP A GROUP B
50. Multiple drug intolerance syndrome: prevalence, clinical
characteristics, and management
Macy, Ann Allergy Asthma Immunol 2012;108:88
Multiple drug % members with at least 1 allergy
intolerance
syndrome (MDIS) 30 –
defined by 3 or more
unrelated drug class
“allergies”. 20 –
20.1%
2,375,424 health 10 –
plan members.
Drug “allergy”. 0
51. Multiple drug intolerance syndrome: prevalence, clinical
characteristics, and management
Macy, Ann Allergy Asthma Immunol 2012;108:88
Multiple drug % members with multiple drug
intolerance intolerance syndrome
syndrome (MDIS)
defined by 3 or more 4 –
unrelated drug class
3 –
“allergies”.
2 –
2,375,424 health
plan members.
2.1%
1 –
Drug “allergy”. 00
52. Multiple drug intolerance syndrome: prevalence, clinical
characteristics, and management
Macy, Ann Allergy Asthma Immunol 2012;108:88
The MDIS
Multiple drug % members with multiple drug
intolerance were
cases intolerance syndrome
syndrome (MDIS)
significantly 4 –
older, 62.4or more
defined by 3 years;
unrelated drug class
heavier, BMI 29.3;
“allergies”.
3 –
and likely to be
2 –
female,
2,375,424 health 2.1%
84.9%
plan members. 1 –
Drug “allergy”. 00
53. Multiple drug intolerance syndrome: prevalence, clinical
characteristics, and management
Macy, Ann Allergy Asthma Immunol 2012;108:88
•Multiple drug intolerance syndrome is in part iatrogenic.
It is associated with overweight elderly women who have
high rates of health care and medication usage. Urticarial
syndromes only explain a small fraction of MDIS cases.
•Multiple drug intolerance syndrome is associated with
anxiety, but not predominately with immunoglobulin E
(IgE)-mediated allergy or life-threatening illness.
•Multiple drug intolerance syndrome can be managed by
medication avoidance and judicious rechallenge.