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Immediate Selective Reactions to NSAIDs: Clinical and Immunological Characteristics.
Abstracts AB157
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
Administration of Fluorescein in Atopic Patients, the Use of Skin Tests and Pretreatment I. Ioannou1, N. Marcomichelakis2, A. Sinaniotis1, I. Papaefthimiou2, E. Syrigou1; 1Allergy Department, Sotiria General Hospital, Athens, GREECE, 2Retinal Department, Cennimatas General Hospital, Athens, GREECE. RATIONALE: Intravenous sodium fluorescein (SF) is used for the examination of the vasculature of the ocular fundus (sodium fluorescein angiography, SFA). Adverse reactions following intravenous SF are very unusual and with unclear pathogenesis. We evaluated whether the skin tests predict SF reaction and if pre-treatment with antihistamines prevents them. METHODS: Prick and intradermal tests with serial dilutions of SF 10%, latex (Alk-Abello) and controls (NaCl 0.9% and histamine 10 mg/ml) were performed in all referred individuals, of a 16 months period. Subsequently, patients were randomized in two groups: group A received 3 doses of cetirizine 13, 7, and 1 hours before iv administration of SF, while group B did not receive any pre-treatment. All patients were evaluated for adverse events following the administration of SF. RESULTS: We included 336 patients (164 men, 172 women) with a mean age of 63.5 years (SD, 12.86; range, 13-89 years, median age 67 years). None of them was found to have positive skin or intradermal testing. The overall rates of adverse reactions were 1.19% (4/336), which consisted of transient nausea, vomiting and face flushing. All 4 patients belonged to group B (4/168, 2.38%), while none of group A patients had any adverse reaction (0/168). CONCLUSIONS: SFA is a relatively safe procedure, with toxicities comparable to other intravenous radiocontrast media angiographies. The negative skin tests exclude an IgE-mediated mechanism, and prophylactic treatment should be considered only in high-risk patients.
617
Immediate Selective Reactions to NSAIDs: Clinical and Immunological Characteristics. I. Don˜a1, C. Rondon2, F. Gomez2, M. J. Torres2, P. Campo2, C. Mayorga1, N. Blanca-Lopez3, G. Canto4; 1Fundacion IMABIS- Carlos Haya Hospital, Ma´laga, SPAIN, 2Carlos Haya Hospital, Ma´laga, SPAIN, 3Infanta Leonor Hospital, Madrid, SPAIN, 4Infanta Leonor Hospital, Ma´laga, SPAIN. OBJECTIVES: NSAIDs are the most frequent medicament involved in hypersensitivity drug reactions. In addition to cross-intolerance, selective IgE or T-cell mediated reactions exist. The aim was to estimate the number of immediate selective responders out of a group evaluated with confirmed NSAIDS hypersensitivity. The clinical characteristics and drugs involved are analyzed. METHODS: A large group of subjects reporting reactions to NSAIDs was evaluated. Skin prick (SP) and intradermal (ID), basophil activation tests (BAT) with pyrazolones, total and specific IgE to aeroallergens and oral provocation tests with NSAIDs were performed. RESULTS: From 662 cases diagnosed, 133 (20%) had selective hypersensitivity reactions. From this group, 76 (57,14%) were immediate, being 70% were female. No differences in total and specific IgE were found compared to a control group. Metamizol was involved in 43%, followed by ibuprofen (17%), diclofenac (15%) and ASA (9%). Anaphylaxis occurred in 57%. No patients had exclusively respiratory symptoms. Skin tests were performed in 33 patients, being positive in 6 patients (18,18%), all of them to metamizol (5 positive in PT and ID and 1 positive in ID). BAT to pyrazolones was positive in 54,34%. A total of 89 challenges were carried out in order to confirm tolerance to other non chemically related compounds. CONCLUSIONS: Pyrazolones are the most frequent NSAIDs implicated in immediate selective reactions, being anaphylaxis the most frequent clinical manifestation. The sensitivity of skin tests and BAT is low; therefore clinic history and confirmation of tolerance to others NSAIDs by challenges can be needed to achieve the diagnosis.
618
Basophil Activation Test For Evaluating Immediate Allergic Reactions To Quinolones A. Aranda1, A. Ariza1, A. Rosado2, P. Chaves1, E. Gomez1, N. Blanca3, C. Vila2, M. Blanca4, C. Mayorga1, M. Torres4; 1Fundacion Imabis-Carlos Haya Hospital, Malaga, SPAIN, 2Allergy Service, Alcorcon Hospital, Madrid, SPAIN, 3Allergy Service, Infanta Leonor Hospital, Madrid, SPAIN, 4 Allergy Service, Carlos Haya Hospital, Malaga, SPAIN. RATIONALE: Quinolones are widely used antimicrobial agents that may induce allergic reactions. Immediate reactions (anaphylaxis and urticaria) are the most frequently described, suggesting an IgE-mediated mechanism. Several methods have been used for diagnosing these reactions. Skin testing is usually irritant, drug provocation tests are not free of risk and no validated in vitro testing is available. The aim of the study was to analyze the role of basophil activation test (BAT) in the evaluation of patients with immediate allergic reactions to quinolones. METHODS: Thirty one patients who developed anaphylaxis (N516) and urticaria (N515) in less than one hour after quinolone administration were evaluated. Controls (N524) were also included in the study. Skin prick and intradermal tests with a panel of quinolones at different concentrations (1, 10, 20, 40 mg/ml) were done. BAT with pipedimic acid, nalidixic acid, ciprofloxacin, ofloxacin, lomefloxacin, moxifloxacin, norfloxacin, levofloxacin were done at different concentrations (4, 2, 0.2, and 0.1 mg/ml). Drug provocation test were not done because of the severity of the reactions RESULTS: Drugs involved in the reactions were ciprofloxacin (N57), moxifloxacin (N521) and levofloxacin (N53). Skin testing yielded false positive results in controls. BAT was positive to the drug involved in the reaction in 53.3% of cases with a specificity of 79%. BAT results were analysed depending on the drug involved in the reaction. More specificity was found with ciprofloxacin (83.3%) and levofloxacin (66.6%). CONCLUSIONS: Skin testing at non irritant concentrations are not useful for diagnosing immediate allergic reactions to quinolones. The BAT has shown to have a good sensitivity and specificity with quinolones.
619
Perceptions Of Radiologists On The Association Between Shellfish Allergy And Risk Of Anaphylaxis To Radiocontrast Media In Canada T. W. C. Pun1, C. Kalicinsky2; 1Memorial University, St John’s, NL, CANADA, 2University of Manitoba, Winnipeg, MB, CANADA. RATIONALE: There is a pervasive myth in the medical community that shellfish allergy precludes the use of radiocontrast media in diagnostic procedures. A study by Beaty et al. in 2006 in the US demonstrated that 37.2% of polled radiologists and interventional cardiologists share this perception. We sought to determine the strength and or existence of this myth in Canada. METHODS: We distributed Dr. Beaty’s survey to radiologists (staff and residents) based at teaching hospitals across Canada. The survey consisted of 8 true/false questions, with 2 questions of interest embedded amongst 6 distractors. RESULTS: Seventy-three percent of responders indicated that they or someone on their behalf inquire about shellfish allergy prior to the administration of contrast. 13.1% of responders would withhold radiocontrast media or recommend premedication with a positive history of shellfish allergy. In the US study, 37.2% of responders would withhold radiocontrast media or recommend premedication with a positive history of shellfish allergy. CONCLUSIONS: The myth associating IgE mediated shellfish allergy and nonimmunologic anaphylactic reactions to radiocontrast media is present in Canada, although perhaps to a lesser degree than that determined by a comparative study in the US.
MONDAY
616
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
Administration of Fluorescein in Atopic Patients, the Use of Skin Tests and Pretreatment I. Ioannou1, N. Marcomichelakis2, A. Sinaniotis1, I. Papaefthimiou2, E. Syrigou1; 1Allergy Department, Sotiria General Hospital, Athens, GREECE, 2Retinal Department, Cennimatas General Hospital, Athens, GREECE. RATIONALE: Intravenous sodium fluorescein (SF) is used for the examination of the vasculature of the ocular fundus (sodium fluorescein angiography, SFA). Adverse reactions following intravenous SF are very unusual and with unclear pathogenesis. We evaluated whether the skin tests predict SF reaction and if pre-treatment with antihistamines prevents them. METHODS: Prick and intradermal tests with serial dilutions of SF 10%, latex (Alk-Abello) and controls (NaCl 0.9% and histamine 10 mg/ml) were performed in all referred individuals, of a 16 months period. Subsequently, patients were randomized in two groups: group A received 3 doses of cetirizine 13, 7, and 1 hours before iv administration of SF, while group B did not receive any pre-treatment. All patients were evaluated for adverse events following the administration of SF. RESULTS: We included 336 patients (164 men, 172 women) with a mean age of 63.5 years (SD, 12.86; range, 13-89 years, median age 67 years). None of them was found to have positive skin or intradermal testing. The overall rates of adverse reactions were 1.19% (4/336), which consisted of transient nausea, vomiting and face flushing. All 4 patients belonged to group B (4/168, 2.38%), while none of group A patients had any adverse reaction (0/168). CONCLUSIONS: SFA is a relatively safe procedure, with toxicities comparable to other intravenous radiocontrast media angiographies. The negative skin tests exclude an IgE-mediated mechanism, and prophylactic treatment should be considered only in high-risk patients.
617
Immediate Selective Reactions to NSAIDs: Clinical and Immunological Characteristics. I. Don˜a1, C. Rondon2, F. Gomez2, M. J. Torres2, P. Campo2, C. Mayorga1, N. Blanca-Lopez3, G. Canto4; 1Fundacion IMABIS- Carlos Haya Hospital, Ma´laga, SPAIN, 2Carlos Haya Hospital, Ma´laga, SPAIN, 3Infanta Leonor Hospital, Madrid, SPAIN, 4Infanta Leonor Hospital, Ma´laga, SPAIN. OBJECTIVES: NSAIDs are the most frequent medicament involved in hypersensitivity drug reactions. In addition to cross-intolerance, selective IgE or T-cell mediated reactions exist. The aim was to estimate the number of immediate selective responders out of a group evaluated with confirmed NSAIDS hypersensitivity. The clinical characteristics and drugs involved are analyzed. METHODS: A large group of subjects reporting reactions to NSAIDs was evaluated. Skin prick (SP) and intradermal (ID), basophil activation tests (BAT) with pyrazolones, total and specific IgE to aeroallergens and oral provocation tests with NSAIDs were performed. RESULTS: From 662 cases diagnosed, 133 (20%) had selective hypersensitivity reactions. From this group, 76 (57,14%) were immediate, being 70% were female. No differences in total and specific IgE were found compared to a control group. Metamizol was involved in 43%, followed by ibuprofen (17%), diclofenac (15%) and ASA (9%). Anaphylaxis occurred in 57%. No patients had exclusively respiratory symptoms. Skin tests were performed in 33 patients, being positive in 6 patients (18,18%), all of them to metamizol (5 positive in PT and ID and 1 positive in ID). BAT to pyrazolones was positive in 54,34%. A total of 89 challenges were carried out in order to confirm tolerance to other non chemically related compounds. CONCLUSIONS: Pyrazolones are the most frequent NSAIDs implicated in immediate selective reactions, being anaphylaxis the most frequent clinical manifestation. The sensitivity of skin tests and BAT is low; therefore clinic history and confirmation of tolerance to others NSAIDs by challenges can be needed to achieve the diagnosis.
618
Basophil Activation Test For Evaluating Immediate Allergic Reactions To Quinolones A. Aranda1, A. Ariza1, A. Rosado2, P. Chaves1, E. Gomez1, N. Blanca3, C. Vila2, M. Blanca4, C. Mayorga1, M. Torres4; 1Fundacion Imabis-Carlos Haya Hospital, Malaga, SPAIN, 2Allergy Service, Alcorcon Hospital, Madrid, SPAIN, 3Allergy Service, Infanta Leonor Hospital, Madrid, SPAIN, 4 Allergy Service, Carlos Haya Hospital, Malaga, SPAIN. RATIONALE: Quinolones are widely used antimicrobial agents that may induce allergic reactions. Immediate reactions (anaphylaxis and urticaria) are the most frequently described, suggesting an IgE-mediated mechanism. Several methods have been used for diagnosing these reactions. Skin testing is usually irritant, drug provocation tests are not free of risk and no validated in vitro testing is available. The aim of the study was to analyze the role of basophil activation test (BAT) in the evaluation of patients with immediate allergic reactions to quinolones. METHODS: Thirty one patients who developed anaphylaxis (N516) and urticaria (N515) in less than one hour after quinolone administration were evaluated. Controls (N524) were also included in the study. Skin prick and intradermal tests with a panel of quinolones at different concentrations (1, 10, 20, 40 mg/ml) were done. BAT with pipedimic acid, nalidixic acid, ciprofloxacin, ofloxacin, lomefloxacin, moxifloxacin, norfloxacin, levofloxacin were done at different concentrations (4, 2, 0.2, and 0.1 mg/ml). Drug provocation test were not done because of the severity of the reactions RESULTS: Drugs involved in the reactions were ciprofloxacin (N57), moxifloxacin (N521) and levofloxacin (N53). Skin testing yielded false positive results in controls. BAT was positive to the drug involved in the reaction in 53.3% of cases with a specificity of 79%. BAT results were analysed depending on the drug involved in the reaction. More specificity was found with ciprofloxacin (83.3%) and levofloxacin (66.6%). CONCLUSIONS: Skin testing at non irritant concentrations are not useful for diagnosing immediate allergic reactions to quinolones. The BAT has shown to have a good sensitivity and specificity with quinolones.
619
Perceptions Of Radiologists On The Association Between Shellfish Allergy And Risk Of Anaphylaxis To Radiocontrast Media In Canada T. W. C. Pun1, C. Kalicinsky2; 1Memorial University, St John’s, NL, CANADA, 2University of Manitoba, Winnipeg, MB, CANADA. RATIONALE: There is a pervasive myth in the medical community that shellfish allergy precludes the use of radiocontrast media in diagnostic procedures. A study by Beaty et al. in 2006 in the US demonstrated that 37.2% of polled radiologists and interventional cardiologists share this perception. We sought to determine the strength and or existence of this myth in Canada. METHODS: We distributed Dr. Beaty’s survey to radiologists (staff and residents) based at teaching hospitals across Canada. The survey consisted of 8 true/false questions, with 2 questions of interest embedded amongst 6 distractors. RESULTS: Seventy-three percent of responders indicated that they or someone on their behalf inquire about shellfish allergy prior to the administration of contrast. 13.1% of responders would withhold radiocontrast media or recommend premedication with a positive history of shellfish allergy. In the US study, 37.2% of responders would withhold radiocontrast media or recommend premedication with a positive history of shellfish allergy. CONCLUSIONS: The myth associating IgE mediated shellfish allergy and nonimmunologic anaphylactic reactions to radiocontrast media is present in Canada, although perhaps to a lesser degree than that determined by a comparative study in the US.
MONDAY
616