- Email: [email protected]
ASA desensitization assisted by monteleukast in patients with nasal polyps, asthma, and ASA sensitivity
J ALLERGY CLIN IMMUNOL VOLUME 111, NUMBER 2
chospasm. After topic application of Ketoprofen he presented two hours later generalized urticaria and angioedema and intense bronchospasm. Case 2: had past history of atopy and urticaria after ingestion of aspirin and topic application of Ketoprofen. Case 3 and 4: referred several episodes of generalized urticaria due to NSAIDs. METHODS: Oral and bronchial provocation test with aspirin for diagnostic confirmation of NI. Cutaneous test consisted in progressive dose application of Ketoprofen. Test was considered positive if cutaneous reaction appeared or Fev~ decreased >20%. RESULTS: In case 1, confirmation was realized with bronchial provocation test with immediate bronchial reaction and urticaria two hours later. The cutaneous test with Ketoprofen was positive (local apparition of hives). No fall of Fevl was observed. In the other three cases the confirmation was obtained by oral provocation with aspirin. The topic application of Ketoprofen did not give any reaction. CONCLUSIONS: Even though the topic application has confirmed NI in one of the patients further studies are necessary to know its utility.
Funding: Self-funded
410 ASA Desensitization Assisted by Monteleukast in Patients with Nasal Polyps, Asthma, and ASA Sensitivity A. S. Cheema ], J. Mendelsohn2; JClinical Research Group, Mississauga, ON, CANADA, 2Ent, Trillium Health Centre, Mississauga, ON, CANADA. RATIONALE: ASA desensitization is usually carried out in the hospital setting. We performed gradual ASA desensitization in the office and home setting in patients who were pretreated with Monteleukast and optimally treated for asthma. METHODS: For one week prior to administration of ASA the patients were on daily Singulair and their asthma was optimally controlled with Flovent and Serevent. Their rhinosinusitis symptoms were treated with nasal steroids. Asthma was stable and FEVI was greater than 70% in all patients, desensitization was begun at 20 mg of ASA on day one and gradually increased thereafter. The patients were maintained on 650 mg of ASA per day. RESULTS: Of the 12 patients, 11 were successfully desensitized. One had urticaria at the dose of 160 mg ASA but was able to complete the desensitization. The other patient had recurrent asthma for 2 to 3 weeks after the desensitization and therefore ASA was discontinued. CONCLUSIONS: With careful selection of patients and use of Singulair along with Flovent and Serevent, ASA desensitization can be carried out to benefit rhinosinusitis symtpoms.
Funding: Selffunded
411
Valdecoxib Is a Safe Alternative Drug for NSAlD-Sensitive Patients with Cutaneous Reactions
M. S~inchez-Borges, A. Capriles-Hulett, F. Caballero-Fonseca; AllergyImmunology, Centro Mrdico-Docente La Trinidad, Caracas, VENEZUELA. RATIONALE: COX-2 selective inhibitors are generally well tolerated by individuals who develop urticaria (U) and angioedema (AE) from NSAIDs that inhibit cyclooxygenase-l. Valdecoxib(4-(5-methyl-3phenyl-4-isoxazolil)benzenesulphonamide) is a new COX-2 specific inhibitor indicated for acute pain, dysmenorrhea, osteoarthritis and rheumatoid arthritis. The objective of this study was to evaluate the tolerance of NSAID-sensitive patients to Rofecoxib and Valdecoxib. PATIENTS AND METHODS: 20 patients (female 14, male 6), aged 29.5+_15 years (range 10-61) with challenge-proven NSAID sensitivity manifested as U or AE were submitted to single-blinded oral challenges with Rofecoxib 50 mg and Valdecoxib 40 mg. Ten subjects had allergic rhinitis, 3 rhinitis and asthma, I asthma alone and 13/16 (81.2%) positive prick tests to aeroallergens. An exclusive cutaneous pattern (U and/or AE) was present in 6 patients and a mixed clinical pattern of skin and respiratory symptoms was observed in 13 subjects, with one patient exhibiting anaphylactoid clinical picture. Half dose of the drug was given one hour apart and the patient was observed in the hospital for three hours. A test was regarded as positive if >20% of surface body area was involved by urticaria or angioedema after challenge. Patients with chronic urticaria were excluded from the study. RESULTS: None of the challenged patients had cutaneous or respiratory
Abstracts
$171
reactions to Valdecoxib. One patient reacted to Rofecoxib 25 mg with laryngeal edema. CONCLUSIONS: Rofecoxib and Valdecoxib are tolerated by the majority of NSAID-sensitive patients with cutaneous reactions. However, controlled challenges should be carried out before administration of highly specific COX-2 inhibitors to these patients.
Funding: Self-funded
412 Severe Delayed Local Reaction to Childhood Vaccina,ions Containing Adjuvants U. K. Reddy, G. Avshalomov, V. R. Bonagura; Allergy and Immunology, Long Island Jewish Medical Center, New Hyde Park, NY. RATIONALE: We report severe local delayed reactions to vaccines occurring in an infant under one year of age resulting in extensive cutaneous scarring to almost all of her childhood vaccinations received by eight months of age. She received diphtheria, pertussis and tetanus combined vaccination, combined Haemophilus influenza B and recombinant hepatitis B, and conjugated pneumococcal vaccine. METHODS: Specific immunoglobulin titers, patch testing, gram stain and culture of aspirated fluid were done. RESULTS: Specific immunoglobulin titers were unusually elevated indicating a vigorous immune response to these vaccines. Gram stain revealed numerous white blood cells, but no organisms. Culture was negative. Patch testing was positive at 48 and 72 hours for aluminum, but negative for thimerosal and formaldehyde. CONCLUSIONS: The etiology of the lesions in this patient are very likely to be secondary to a DTH reaction to the aluminum adjuvant contained the vaccinations received. Sterile abscess is unlikely given the multiplicity of lesions and the high vaccine-specific immunoglobulin titers, both of which are atypical features sterile abscess. Given the potential for permanent disfigurement, physicians should be cognizant of the possibility of local DTH reactions to adjuvants in vaccinations that enhance immunogenicity, but can cause severe cutaneous side effects. In patients showing signs of DTH like reactions to vaccines, preparations devoid of these components should be sought and administered in place of those containing the offending agents.
Funding: Division of Allergy Immunology l_zmgIsland Jewish Medical
4 1 3 ,e,.,,o.s,,,o,O.se,
Degree of Systemic Allergic Reactions to Measles, Mumps, and Rubella Vaccines
M. Sakaguchi, K. Tanuguchi, S. Inouye; National Institute of Infectious Diseases, Tokyo, JAPAN. RATIONALE: To examine the relationship between sensitization to gelatin, onset time and degree of systemic allergic reactions to measles, mumps, and rubella vaccines, we analyzed the cases of systemic allergic reactions. METHODS: We collected 521 case reports and serum samples from patients who had experienced anaphylaxis or other allergic reactions to these vaccines and measured anti-gelatin lgE in the serum samples. RESULTS: The cases were classified into three groups according to the degree of symptoms. The first group consisted of 37 patients that had developed severe, life-threatening anaphylaxis and 92% of these patients were positive for anti-gelatin IgE. All 37 patients developed anaphylaxis within one hour after vaccination. The second group consisted of 56 patients showing mild anaphylaxis and 95% of these were positive for anti-gelatin lgE. Of the 56 patients, 55 showed mild anaphylaxis within one hour after vaccination and one patient developed symptoms 3 hours after vaccination. The third group consisted of 428 patients showing only systemic cutaneous reactions to the vaccines. Of the 428 patients, 86 developed allergic reactions within one hour after vaccination and 81% of the 86 patients were positive for anti-gelatin lgE. The other 342 patients developed allergic reactions more than one hour after vaccination but only 6% of these patients were positive for anti-gelatin IgE. CONCLUSIONS: Apparent life-threatening anaphylaxis to the vaccines containing gelatin occurred within one hour after vaccination. The onset time of the allergic reactions to these vaccines depended upon the severity of the reactions.
Funding: Self-funded
chospasm. After topic application of Ketoprofen he presented two hours later generalized urticaria and angioedema and intense bronchospasm. Case 2: had past history of atopy and urticaria after ingestion of aspirin and topic application of Ketoprofen. Case 3 and 4: referred several episodes of generalized urticaria due to NSAIDs. METHODS: Oral and bronchial provocation test with aspirin for diagnostic confirmation of NI. Cutaneous test consisted in progressive dose application of Ketoprofen. Test was considered positive if cutaneous reaction appeared or Fev~ decreased >20%. RESULTS: In case 1, confirmation was realized with bronchial provocation test with immediate bronchial reaction and urticaria two hours later. The cutaneous test with Ketoprofen was positive (local apparition of hives). No fall of Fevl was observed. In the other three cases the confirmation was obtained by oral provocation with aspirin. The topic application of Ketoprofen did not give any reaction. CONCLUSIONS: Even though the topic application has confirmed NI in one of the patients further studies are necessary to know its utility.
Funding: Self-funded
410 ASA Desensitization Assisted by Monteleukast in Patients with Nasal Polyps, Asthma, and ASA Sensitivity A. S. Cheema ], J. Mendelsohn2; JClinical Research Group, Mississauga, ON, CANADA, 2Ent, Trillium Health Centre, Mississauga, ON, CANADA. RATIONALE: ASA desensitization is usually carried out in the hospital setting. We performed gradual ASA desensitization in the office and home setting in patients who were pretreated with Monteleukast and optimally treated for asthma. METHODS: For one week prior to administration of ASA the patients were on daily Singulair and their asthma was optimally controlled with Flovent and Serevent. Their rhinosinusitis symptoms were treated with nasal steroids. Asthma was stable and FEVI was greater than 70% in all patients, desensitization was begun at 20 mg of ASA on day one and gradually increased thereafter. The patients were maintained on 650 mg of ASA per day. RESULTS: Of the 12 patients, 11 were successfully desensitized. One had urticaria at the dose of 160 mg ASA but was able to complete the desensitization. The other patient had recurrent asthma for 2 to 3 weeks after the desensitization and therefore ASA was discontinued. CONCLUSIONS: With careful selection of patients and use of Singulair along with Flovent and Serevent, ASA desensitization can be carried out to benefit rhinosinusitis symtpoms.
Funding: Selffunded
411
Valdecoxib Is a Safe Alternative Drug for NSAlD-Sensitive Patients with Cutaneous Reactions
M. S~inchez-Borges, A. Capriles-Hulett, F. Caballero-Fonseca; AllergyImmunology, Centro Mrdico-Docente La Trinidad, Caracas, VENEZUELA. RATIONALE: COX-2 selective inhibitors are generally well tolerated by individuals who develop urticaria (U) and angioedema (AE) from NSAIDs that inhibit cyclooxygenase-l. Valdecoxib(4-(5-methyl-3phenyl-4-isoxazolil)benzenesulphonamide) is a new COX-2 specific inhibitor indicated for acute pain, dysmenorrhea, osteoarthritis and rheumatoid arthritis. The objective of this study was to evaluate the tolerance of NSAID-sensitive patients to Rofecoxib and Valdecoxib. PATIENTS AND METHODS: 20 patients (female 14, male 6), aged 29.5+_15 years (range 10-61) with challenge-proven NSAID sensitivity manifested as U or AE were submitted to single-blinded oral challenges with Rofecoxib 50 mg and Valdecoxib 40 mg. Ten subjects had allergic rhinitis, 3 rhinitis and asthma, I asthma alone and 13/16 (81.2%) positive prick tests to aeroallergens. An exclusive cutaneous pattern (U and/or AE) was present in 6 patients and a mixed clinical pattern of skin and respiratory symptoms was observed in 13 subjects, with one patient exhibiting anaphylactoid clinical picture. Half dose of the drug was given one hour apart and the patient was observed in the hospital for three hours. A test was regarded as positive if >20% of surface body area was involved by urticaria or angioedema after challenge. Patients with chronic urticaria were excluded from the study. RESULTS: None of the challenged patients had cutaneous or respiratory
Abstracts
$171
reactions to Valdecoxib. One patient reacted to Rofecoxib 25 mg with laryngeal edema. CONCLUSIONS: Rofecoxib and Valdecoxib are tolerated by the majority of NSAID-sensitive patients with cutaneous reactions. However, controlled challenges should be carried out before administration of highly specific COX-2 inhibitors to these patients.
Funding: Self-funded
412 Severe Delayed Local Reaction to Childhood Vaccina,ions Containing Adjuvants U. K. Reddy, G. Avshalomov, V. R. Bonagura; Allergy and Immunology, Long Island Jewish Medical Center, New Hyde Park, NY. RATIONALE: We report severe local delayed reactions to vaccines occurring in an infant under one year of age resulting in extensive cutaneous scarring to almost all of her childhood vaccinations received by eight months of age. She received diphtheria, pertussis and tetanus combined vaccination, combined Haemophilus influenza B and recombinant hepatitis B, and conjugated pneumococcal vaccine. METHODS: Specific immunoglobulin titers, patch testing, gram stain and culture of aspirated fluid were done. RESULTS: Specific immunoglobulin titers were unusually elevated indicating a vigorous immune response to these vaccines. Gram stain revealed numerous white blood cells, but no organisms. Culture was negative. Patch testing was positive at 48 and 72 hours for aluminum, but negative for thimerosal and formaldehyde. CONCLUSIONS: The etiology of the lesions in this patient are very likely to be secondary to a DTH reaction to the aluminum adjuvant contained the vaccinations received. Sterile abscess is unlikely given the multiplicity of lesions and the high vaccine-specific immunoglobulin titers, both of which are atypical features sterile abscess. Given the potential for permanent disfigurement, physicians should be cognizant of the possibility of local DTH reactions to adjuvants in vaccinations that enhance immunogenicity, but can cause severe cutaneous side effects. In patients showing signs of DTH like reactions to vaccines, preparations devoid of these components should be sought and administered in place of those containing the offending agents.
Funding: Division of Allergy Immunology l_zmgIsland Jewish Medical
4 1 3 ,e,.,,o.s,,,o,O.se,
Degree of Systemic Allergic Reactions to Measles, Mumps, and Rubella Vaccines
M. Sakaguchi, K. Tanuguchi, S. Inouye; National Institute of Infectious Diseases, Tokyo, JAPAN. RATIONALE: To examine the relationship between sensitization to gelatin, onset time and degree of systemic allergic reactions to measles, mumps, and rubella vaccines, we analyzed the cases of systemic allergic reactions. METHODS: We collected 521 case reports and serum samples from patients who had experienced anaphylaxis or other allergic reactions to these vaccines and measured anti-gelatin lgE in the serum samples. RESULTS: The cases were classified into three groups according to the degree of symptoms. The first group consisted of 37 patients that had developed severe, life-threatening anaphylaxis and 92% of these patients were positive for anti-gelatin IgE. All 37 patients developed anaphylaxis within one hour after vaccination. The second group consisted of 56 patients showing mild anaphylaxis and 95% of these were positive for anti-gelatin lgE. Of the 56 patients, 55 showed mild anaphylaxis within one hour after vaccination and one patient developed symptoms 3 hours after vaccination. The third group consisted of 428 patients showing only systemic cutaneous reactions to the vaccines. Of the 428 patients, 86 developed allergic reactions within one hour after vaccination and 81% of the 86 patients were positive for anti-gelatin lgE. The other 342 patients developed allergic reactions more than one hour after vaccination but only 6% of these patients were positive for anti-gelatin IgE. CONCLUSIONS: Apparent life-threatening anaphylaxis to the vaccines containing gelatin occurred within one hour after vaccination. The onset time of the allergic reactions to these vaccines depended upon the severity of the reactions.
Funding: Self-funded