Ranitidine-induced anaphylaxis: clinical features, cross-reactivity, and skin testing

2016 ◽  
Vol 46 (4) ◽  
pp. 631-639 ◽  
Author(s):  
K. H. Park ◽  
J. Pai ◽  
D.-G. Song ◽  
D. W. Sim ◽  
H. J. Park ◽  
...  
Keyword(s):  
Clinical Features ◽  
Skin Testing ◽  
Cross Reactivity

scholarly journals 162. Assessment of Beta-lactam Allergies as Rationale for Receipt of Vancomycin for Surgical Prophylaxis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S90
Author(s):  
Kendall J Tucker ◽  
YoungYoon Ham ◽  
Haley K Holmer ◽  
Caitlin M McCracken ◽  
Ellie Sukerman ◽  
...  
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Penicillin Allergy ◽  
Beta Lactam ◽  
First Line ◽  
Surgical Prophylaxis ◽  
Inappropriate Use ◽  
Oral Amoxicillin ◽  
Ige Mediated

Abstract Background Beta-lactam (BL) antibiotics are first-line agents for most patients receiving antimicrobial prophylaxis in surgical procedures. Despite evidence showing low cross-reactivity between classes of BLs, patients with allergies commonly receive vancomycin as an alternative to avoid allergic reaction. The objective of this study was to identify potentially inappropriate use of vancomycin surgical prophylaxis among patients with reported BL allergies. Methods Adult patients (≥18 years) receiving vancomycin for surgical prophylaxis with a reported penicillin and/or cephalosporin allergy at our institution between August 2017 to July 2018 were retrospectively evaluated for potential eligibility for penicillin allergy testing and/or receipt of standard prophylaxis. Surgery type and allergy history were extracted from the electronic medical record. Per our institution’s penicillin-testing protocol, patients with IgE-mediated reactions < 10 years ago were eligible for penicillin skin testing (PST), mild reactions or IgE-mediated reaction > 10 years ago were eligible for direct oral amoxicillin challenge, and severe non-IgE mediated allergies were ineligible for penicillin allergy evaluation or BL prophylaxis. Results Among 830 patients who received vancomycin for surgical prophylaxis, 196 reported BL allergy and were included in the analysis (155 with penicillin allergy alone; 21 with cephalosporin allergy; 20 with both cephalosporin and penicillin allergy). Approximately 40% of surgeries were orthopedic. Six patients were ineligible for BL prophylaxis. Per institutional protocol, 73 of 155 patients (48%) may have qualified for PST; 81 of 155 (52%) patients may have received a direct oral amoxicillin challenge. Only 3 of 22 patients with history of methicillin-resistant Staphylococcus aureus appropriately received additional prophylaxis with vancomycin and a BL. Conclusion Patients with BL allergies often qualify for receipt of a first-line BL antibiotic. An opportunity exists for improved BL allergy assessment as an antimicrobial stewardship intervention. Future studies should evaluate outcomes associated with BL allergy evaluation and delabeling in patients receiving surgical prophylaxis. Disclosures All Authors: No reported disclosures

Abstract 16015: A Rare Cutaneous Adverse Drug Reaction With Apixaban

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Khezar Syed ◽  
Haseeb Chaudhary ◽  
Tayyab Ali Waheed ◽  
Ansar Aziz
Keyword(s):  
Serum Creatinine ◽  
Early Recognition ◽  
Atrial Fibrillation Patient ◽  
Skin Testing ◽  
Oral Anticoagulants ◽  
Elevated Serum ◽  
Cross Reactivity ◽  
Cell Counts ◽  
Macular Rash ◽  
Direct Acting

We report a case of apixaban-induced macular rash noticed 3 days after its initiation for atrial fibrillation. Patient denied any fever, arthralgias, myalgias or photosensitivity otherwise. On presentation, she complained of generalized pruritus with a bilateral non-blanchable macular rash on distal lower extremities and dorsum of feet. The labs showed normal cell counts, an elevated serum creatinine of 2.29mg/dl with a bland urine on microscopy. Apixaban was switched to LMWH. Serum creatinine returned to baseline with fluid therapy within 24 hours. Patient was re-challenged with apixaban that caused recurrence of generalized pruritus. It was treated successfully with diphenhydramine and prednisone. She was restarted on LMWH and rash disappeared after 3 days of stopping apixaban. She was later commenced on rivaroxaban without any complications. Several cutaneous adverse drug reactions (cADR) have been reported with direct acting oral anticoagulants (DOAC) like rivaroxaban and edoxaban but are extremely rare with apixaban. The overall reported incidence of dermatologic immune reactions with FXa inhibitors is <0.1%. Previously reported skin eruptions from apixaban include palmoplantar psoriasiform rash, leucocytoclastic vasculitis and acute generalized erythematous pustulosis. Our patient’s Naranjo scale was 7 and her rash improved after cessation of apixaban. The case illustrates a hypersensitivity reaction from apixaban that did not have cross-reactivity with other FXa inhibitors. Early recognition of cADR from this widely used DOAC can avoid potential complications. Minor reactions may be managed by switching to different DOAC therapy. Whether a cross-reactivity truly exists must be explored by validated skin testing.

scholarly journals Ceftaroline Desensitization Procedure in a Pregnant Patient With Multiple Drug Allergies

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
James L. Kuhlen ◽  
Kimberly G. Blumenthal ◽  
Caroline L. Sokol ◽  
Diana S. Balekian ◽  
Ana A. Weil ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Skin Testing ◽  
Pregnant Patient ◽  
Cross Reactivity ◽  
Multiple Drug ◽  
Methicillin Resistant ◽  
The Cross ◽  
Staphylococcus Aureus Pneumonia

Abstract Validated skin testing is lacking for many drugs, including ceftaroline. The cross-reactivity between ceftaroline and other β-lactam antibiotics is unknown. We report a case of a pregnant patient with cystic fibrosis and multiple drug allergies who required ceftaroline for methicillin-resistant Staphylococcus aureus pneumonia and underwent an uncomplicated empiric desensitization procedure.

Clinical Features of Wheat Allergy Are Significantly Different between Tri a 14 Sensitized Patients and Tri a 19 Sensitized Ones

2021 ◽  
pp. 1-9
Author(s):  
Elide Anna Pastorello ◽  
Alessandro Toscano ◽  
Giuseppe Scibilia ◽  
Chrysi Stafylaraki ◽  
Carlo Maria Rossi ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Clinical Features ◽  
Food Challenge ◽  
Cross Reactivity ◽  
Clinical Aspects ◽  
Wheat Allergy ◽  
Inverse Relation ◽  
Food Avoidance ◽  
High Consumption ◽  
Clinical Pictures

<b><i>Introduction:</i></b> Wheat is the most important cereal for human nutrition but its high consumption is associated to an increasing complaint of wheat-related disorders, many of which are allergic in nature and different in respect to the involved allergens. In this study, we compared the clinical aspects of wheat allergy presented by patients sensitized to Tri a 19 in respect to those presented by patients sensitized to Tri a 14. <b><i>Methods:</i></b> With this aim, we selected patients sensitized to 1 or both of the 2 allergens, and among these we identified those who were really wheat allergic and reactive on the basis of a standardized methodology. We evaluated the clinical features such as the kind and severity of symptoms, the coexistence of triggering factors such as physical exercise and NSAIDs and alcohol consumption, and the association with other allergens and with various immunologic parameters. Wheat allergy in Tri a 19 sensitized patients was confirmed through a questionnaire while the patients sensitized to Tri a 14 underwent wheat challenge with 100 g of pasta followed by exercise on a treadmill. <b><i>Results:</i></b> Seventy-nine patients sensitized to Tri a 14 and 40 patients sensitized to Tri a 19 were recruited. The 2 sensitizations were independent with a significant inverse relation (<i>p</i> &#x3c; 0.00001). The Tri a 19 sensitized patients presented, in respect to the Tri a 14 sensitized ones, an older age (<i>p</i> = 0.0017), a higher risk to be wheat allergic (<i>p</i> &#x3c; 0.0001), a higher severity of the reactions (<i>p</i> &#x3c; 0.00001) and a higher association with some cofactors, namely alcohol (<i>p</i> &#x3c; 0.0005) and physical exercise (<i>p</i> = 0.003). On the contrary, Tri a 14 sensitization was associated with atopy (<i>p</i> &#x3c; 0.0001), with a higher probability of patients being asymptomatic (<i>p</i> &#x3c; 0.0001) and being sensitized to other foods, in particular to nuts and cereals (<i>p</i> &#x3c; 0.00001). <b><i>Conclusions:</i></b> Sensitization to Tri a 19 or Tri a 14 determines different clinical pictures. In particular, sensitization to Tri a 19 implies a higher probability of severe reactions, even dependent on daily triggers, while that to Tri a 14 implies a higher cross-reactivity with other foods but it’s more frequently asymptomatic, making a food challenge necessary to prevent useless food avoidance.

scholarly journals Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Manzo Suzuki ◽  
Hajime Kawase ◽  
Azusa Ogita ◽  
Hiroyasu Bito
Keyword(s):  
General Anesthesia ◽  
Skin Testing ◽  
Blocking Agent ◽  
Cross Reactivity ◽  
Neuromuscular Blocking ◽  
Intradermal Test ◽  
Skin Tests ◽  
Prick Test ◽  
Causative Drug ◽  
Ige Mediated

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

Immediate- and delayed-type allergic reactions to amide local anesthetics: clinical features and skin testing

2009 ◽  
Vol 18 (7) ◽  
pp. 595-601 ◽  
Author(s):  
Régis Fuzier ◽  
Maryse Lapeyre-Mestre ◽  
Paul-Michel Mertes ◽  
Jean-François Nicolas ◽  
Yves Benoit ◽  
...  
Keyword(s):  
Clinical Features ◽  
Local Anesthetics ◽  
Skin Testing ◽  
Allergic Reactions

scholarly journals New Skin Test for Detection of Bovine Tuberculosis on the Basis of Antigen-Displaying Polyester Inclusions Produced by Recombinant Escherichia coli

2014 ◽  
Vol 80 (8) ◽  
pp. 2526-2535 ◽  
Author(s):  
Shuxiong Chen ◽  
Natalie A. Parlane ◽  
Jason Lee ◽  
D. Neil Wedlock ◽  
Bryce M. Buddle ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Skin Test ◽  
Skin Testing ◽  
Cross Reactivity ◽  
Pha Synthase ◽  
Enzyme Linked Immunosorbent Assay ◽  
Content Type ◽  
Flight Mass Spectrometry ◽  
Environmental Mycobacteria ◽  
Test Specificity

ABSTRACTThe tuberculin skin test for diagnosing tuberculosis (TB) in cattle lacks specificity if animals are sensitized to environmental mycobacteria, as some antigens in purified protein derivative (PPD) prepared fromMycobacterium bovisare present in nonpathogenic mycobacteria. Three immunodominant TB antigens, ESAT6, CFP10, and Rv3615c, are present in members of the pathogenicMycobacterium tuberculosiscomplex but absent from the majority of environmental mycobacteria. These TB antigens have the potential to enhance skin test specificity. To increase their immunogenicity, these antigens were displayed on polyester beads by translationally fusing them to a polyhydroxyalkanoate (PHA) synthase which mediated formation of antigen-displaying inclusions in recombinantEscherichia coli. The most common form of these inclusions is poly(3-hydroxybutyric acid) (PHB). The respective fusion proteins displayed on these PHB inclusions (beads) were identified using tryptic peptide fingerprinting analysis in combination with matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). The surface exposure and accessibility of antigens were assessed by enzyme-linked immunosorbent assay (ELISA). Polyester beads displaying all three TB antigens showed greater reactivity with TB antigen-specific antibody than did beads displaying only one TB antigen. This was neither due to cross-reactivity of antibodies with the other two antigens nor due to differences in protein expression levels between beads displaying single or three TB antigens. The triple-antigen-displaying polyester beads were used for skin testing of cattle and detected all cattle experimentally infected withM. boviswith no false-positive reactions observed in those sensitized to environmental mycobacteria. The results suggested applicability of TB antigen-displaying polyester inclusions as diagnostic reagents for distinguishing TB-infected from noninfected animals.

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