Converter Phenotype: A New Profile That Is Not Exclusive to Taxanes

Introduction: Phenotype I hypersensitivity reactions are the most commonly reported drug reactions; however, precision medicine has made it possible to characterize new phenotypes. A recent communication proposed the existence of a “converter phenotype,” which would affect patients who present non-immediate hypersensitivity reactions and in subsequent exposures develop immediate hypersensitivity reactions. This study aimed to describe the clinical characteristics of converter phenotype reactions and their evolution during desensitization to chemotherapeutic drugs and monoclonal antibodies.Methods: We retrospectively reviewed our database of patients undergoing desensitization to chemotherapy or biological agents and selected those with a converter phenotype. Demographic and clinical characteristics of the patients, the results of skin tests, tryptase and IL-6 levels, and desensitization outcomes were assessed.Results: Of 116 patients evaluated, 12 (10.3%) were identified as having a converter phenotype. The median interval between drug exposure and reaction was 90.6 h (range 8-288 h). After the conversion, phenotype I was the most frequent (58.3%), followed by cytokine release reactions (33.3%). Fifty-one desensitizations were undertaken and all treatments completed, with 10 (19.6%) breakthrough reactions. No new changes in the phenotype were detected.Conclusions: The symptoms of non-immediate drug hypersensitivity reactions may indicate the need for an early allergological evaluation to assess the risk of future immediate drug reactions. Clinical characteristics, skin test results, and biomarkers can help predict responses to rapid drug desensitization, guiding clinicians on how to optimize therapy delivery while maintaining patient safety.

Delirium in geriatric patients

SummaryDelirium is the most common acute disorder of cognitive function in older patients. Delirium is life threatening, often under-recognized, serious, and costly. The causes are multifactorial, with old age and neurocognitive disorders as the main risk factors. Etiologies are various and multifactorial, and often related to acute medical illness, adverse drug reactions, or medical complications. To date, diagnosis is clinically based, depending on the presence or absence of certain features. In view of the multifactorial etiology, multicomponent approaches seem most promising for facing patients’ needs. Pharmacological intervention, neither for prevention nor for treatment, has been proven effective unanimously. This article reviews the current clinical practice for delirium in geriatric patients, including etiology, pathophysiology, diagnosis, prognosis, treatment, prevention, and outcomes.

Analysis of Influence Factors of Quality of Life of Lung Cancer Patients with Skin Adverse Drug Reactions Under Targeted Therapy

Purpose This study was to assess the status of quality of life and explore the possible factors correlated with quality of life among non-small cell lung cancer (NSCLC) patients with skin adverse drug reactions under targeted therapy. Methods We performed a cross-sectional study including 536 NSCLC patients with skin adverse drug reactions by targeted therapy in cancer outpatient clinics of three hospitals in China between May 2020 and May 2021. And we collected data with structured questionnaires and identified the relationships among coping style, self-management and quality of life by Pearson correlation analysis and multiple linear regression algorithm. Results The total score of quality of life was 46±12.84 in 536 NSCLC patients with skin adverse drug reactions undergoing targeted therapy. In multiple linear regression analysis, we identified the significant factors associated with quality of life including age, education level, combination of medicine, Charlson Comorbidity Index (CCI), stages of disease, facing, yield, symptom management, daily activity management, psychological and emotional management, self-efficacy and self-management (P < 0.05). Conclusions NSCLC patients with skin adverse drug reactions undergoing targeted therapy generally had a compromised quality of life. And the critical factors that affected the status of quality of life were age, education level, co-morbidity, the combinatorial application of drugs and stage of disease, self-management and coping styles.