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Sensitization to Penicillin in Adolescents with Rheumatic Fever
AB194 Abstracts
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
743
745
744
746
Allergenicity of Topical Flucinolone Acetonide 0.01% in Peanut Oil in a Patient Previously Sensitized to Peanuts M. Shams1, R. Kado1, S. J. Maleki2, C. Mattison2, J. El-Dahr1; 1Tulane University School of Medicine, New Orleans, LA, 2United States Department of Agriculture-Agriculture Research Science, New Orleans, LA. RATIONALE: Flucinolone Acetonide 0.01% in peanut oil is marketed as a treatment for atopic dermatitis (AD). The peanut oil used in this therapeutic is heat-processed, refined, and is claimed to be absent of allergenic components. We report a 3-year old girl diagnosed with peanut allergy and AD who flared significantly after using Flucinolone Acetonide 0.01% in peanut oil and in a preliminary analysis of the product using biochemical and molecular methods, we are determining if the patient’s reaction is due to the presence of peanut or other protein allergens in the oil. METHODS: Samples of commercial Flucinolone Acetonide 0.01% in peanut oil were extracted using an array of buffer solutions including NH4HCO3 100 mM, 1% SDS, Phenol, 300M solution of 60mMTris and 0.5 M EDTA, 50% Ethanol, 50% Methanol, 3M urea with multiple cycles of mixing and heating followed by centrifugation. The resultant extracts were analyzed for the presence of protein using several methods including 280 nm absorbance, protein assay kit, and SDS-PAGE. RESULTS: In each case, our results qualitatively indicate the presence of protein in the extraction samples. Precise levels could not be determined, but a combination of other spectroscopic methods and mass-spectrometry will be used to quantify and identify the causative proteins. CONCLUSIONS: Although the levels of protein found in highly refined peanut oils do not seem to cause a reaction when taken orally, the topical use of this oil, as a base for Flucinolone Acetonide, may have to be contraindicated in peanut allergic AD patients and an advisory label stated on the packaging.
MONDAY
Clinical Value Of Skin Tests In Predicting Hypersensitivity Reactions To Radiocontrast Media W. Song1,2, M. Kim1,2, S. Lee1,2, T. Kim1,2, S. Kim1,3, H. Kang1,2, H. Park1,2, S. Kim1,2, Y. Chang1,3, S. Cho1,2, S. Chang4, K. Min1,2, Y. Kim1,5; 1Department of Internal Medicine, Seoul National University Hospital, Seoul, KOREA, REPUBLIC OF, 2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, KOREA, REPUBLIC OF, 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, KOREA, REPUBLIC OF, 4Department of Internal Medicine, Sung-Ae General Hospital, Bucheon, KOREA, REPUBLIC OF, 5Eulji Medical Center, Seoul, KOREA, REPUBLIC OF. RATIONALE: Recent studies have suggested the role of skin tests in the diagnosis of radiocontrast media (RCM) hypersensitivity. We aimed to evaluate the clinical value of skin tests in predicting RCM reactions. METHODS: We analyzed the skin test results of 15 patients referred to allergy clinic for the RCM-induced immediate-type hypersensitivity reactions retrospectively. In addition, 531 subjects scheduled for CT scans using RCM were recruited prospectively and intradermal tests using the same media were performed before the scan on the test day. RESULTS: Retrospective analysis revealed that intradermal test was positive in six patients (40.0%). Interestingly, all of them had experienced severe reactions accompanied with systemic symptoms. The sensitivity of skin test was 66.6% (6/9) in the patients with severe immediate reaction. In the prospective study, five hundred and thirty subjects (99.8%) showed negative intradermal responses. Forty-three subjects (8.1%) developed immediate adverse reactions during CT scans, but all of them were mild or cutaneous reactions. One subject (0.2%) who showed positive skin response could undergo CT scan safely by switching to alternative RCM suggested by additional skin tests. CONCLUSIONS: RCM skin test had a diagnostic value in only severe immediate-type reaction. RCM skin pre-testing had a negative predictive value of 91.9%. The negative predictive value increased to nearly 100% in case of severe systemic reactions. Further large-scaled prospective study is needed, but our data suggest skin tests may be useful to rule out severe systemic adverse reactions before RCM exposure.
Angiotensin Coverting Enzyme Inhibitors: Managing drug allergic cross-reactivity P. Poza-Guedes, R. Gonzalez-Perez, V. Matheu; HUNS La Candelaria, Santa Cruz de Tenerife, SPAIN. RATIONALE: Angiotensin Coverting Enzyme Inhibitors (ACE-Is) are commonly the choice for managing hypertension. Skin adverse reacctions to ACE-Is and a possible allergic cross-reactivity among groups has not been well elucidated. METHODS: A 62 year-old lady was referred to our Unit after developing a generalized skin adverse reaction described as an ‘‘pruritic acute urticaria’’ after the intake of lisinopril that she has been taking for the last 2 years. The onset after the drug intake was 6 hours, lasting 24 hours with complete skin recovery after i.v. steroids and antihistaminics. No signs of angioedema or systemic symptoms were associated to the urticaria. RESULTS: Drug allergy work-up included epicutaneous test (Patch test) with different ACE-Is (lisinopril, captopril, enalapril and fosinopril) with negative readings at 48/96 in all cases. Skin prick test and intradermal testing (1/10) with lisinopril, captopril, enalapril and fosinopril showed negative immediate readings. Subsequently (and separate by 6 weeks each), 2 single blind placebo controlled oral challenges (SBPCOC) with increasing dosis of enalapril (20 mg) and captopril (12,5 mg) were positive developing accelerated (6hours) pruritic maculopapular urticaria in both cases. A final SBPCOC with increasing doses of fosinopril 20 mg was negative. CONCLUSION: A non-immediate skin type allergic reaction to 2 pharmacologically different structured ACE-Is (carboxylic and sulphide groups) was confirmed by SBPCOC. Interestingly a SBPCOC with a phosphoryl ACE-Is discarded allergic cross-reactivity among the 3 chemical groups and provided a safe therapeutic alternative. Further studies are currently needed to achieve a better understanding on the pathogenesis and management of this issue.
Sensitization to Penicillin in Adolescents with Rheumatic Fever M. M. R. Felix, F. C. Kuschnir, A. J. L. A. Cunha; Federal University of Rio de Janeiro, Rio de Janeiro, BRAZIL. RATIONALE: Estimate the prevalence of sensitization to penicillin among adolescents in treatment for rheumatic fever (RF). METHODS: Cross-sectional study conducted at the Center for Adolescent Health - State University of Rio de Janeiro (NESA-UERJ), Brazil, with patients between 10-19 years. Underwent a questionnaire with data about penicillin hypersensitivity, skin prick tests (SPT) with benzylpenicillin 10.000U/ml and aeroallergens (AL). The total number of injections of benzathine penicillin (TBP) was calculated. The differences in relation to gender, age and atopy among reactors (R) and non-reactors (NR) to SPT for penicillin were analyzed by c2 test and those on the TBP by Student’s t-test (significant p<0.05). Approved by the ethics committee of NESA-UERJ. RESULTS: Between Jan to Dec 2009, we evaluated 75 patients (37 females; mean age: 15.95 6 2.14 yr). Of this total, 8% were sensitive for penicillin. History of previous adverse reaction to penicillin was seen in 2 R (33%) and 2 NR (2.9%) (OR516.7;95%CI:1,85-151).There was no significant difference between R and NR in relation to gender and age. The average of TBP in R and NR were 77.2 and 107.5 respectively (p<0.001). All R had positive SPT for AL while among NR this percentage was 39.1% (OR51.42;95%CI:1,07-1,9).There were no allergic reactions to penicillin testing. CONCLUSIONS: Sensitization to penicillin was low among adolescents with RF. Atopy, history of previous reaction to penicillin and lower TBP were significantly associated with positive SPT to penicillin. Benzylpenicillin proved to be safe and able to confirm sensitization in patients with history of allergy to penicillin.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
743
745
744
746
Allergenicity of Topical Flucinolone Acetonide 0.01% in Peanut Oil in a Patient Previously Sensitized to Peanuts M. Shams1, R. Kado1, S. J. Maleki2, C. Mattison2, J. El-Dahr1; 1Tulane University School of Medicine, New Orleans, LA, 2United States Department of Agriculture-Agriculture Research Science, New Orleans, LA. RATIONALE: Flucinolone Acetonide 0.01% in peanut oil is marketed as a treatment for atopic dermatitis (AD). The peanut oil used in this therapeutic is heat-processed, refined, and is claimed to be absent of allergenic components. We report a 3-year old girl diagnosed with peanut allergy and AD who flared significantly after using Flucinolone Acetonide 0.01% in peanut oil and in a preliminary analysis of the product using biochemical and molecular methods, we are determining if the patient’s reaction is due to the presence of peanut or other protein allergens in the oil. METHODS: Samples of commercial Flucinolone Acetonide 0.01% in peanut oil were extracted using an array of buffer solutions including NH4HCO3 100 mM, 1% SDS, Phenol, 300M solution of 60mMTris and 0.5 M EDTA, 50% Ethanol, 50% Methanol, 3M urea with multiple cycles of mixing and heating followed by centrifugation. The resultant extracts were analyzed for the presence of protein using several methods including 280 nm absorbance, protein assay kit, and SDS-PAGE. RESULTS: In each case, our results qualitatively indicate the presence of protein in the extraction samples. Precise levels could not be determined, but a combination of other spectroscopic methods and mass-spectrometry will be used to quantify and identify the causative proteins. CONCLUSIONS: Although the levels of protein found in highly refined peanut oils do not seem to cause a reaction when taken orally, the topical use of this oil, as a base for Flucinolone Acetonide, may have to be contraindicated in peanut allergic AD patients and an advisory label stated on the packaging.
MONDAY
Clinical Value Of Skin Tests In Predicting Hypersensitivity Reactions To Radiocontrast Media W. Song1,2, M. Kim1,2, S. Lee1,2, T. Kim1,2, S. Kim1,3, H. Kang1,2, H. Park1,2, S. Kim1,2, Y. Chang1,3, S. Cho1,2, S. Chang4, K. Min1,2, Y. Kim1,5; 1Department of Internal Medicine, Seoul National University Hospital, Seoul, KOREA, REPUBLIC OF, 2Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, KOREA, REPUBLIC OF, 3Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, KOREA, REPUBLIC OF, 4Department of Internal Medicine, Sung-Ae General Hospital, Bucheon, KOREA, REPUBLIC OF, 5Eulji Medical Center, Seoul, KOREA, REPUBLIC OF. RATIONALE: Recent studies have suggested the role of skin tests in the diagnosis of radiocontrast media (RCM) hypersensitivity. We aimed to evaluate the clinical value of skin tests in predicting RCM reactions. METHODS: We analyzed the skin test results of 15 patients referred to allergy clinic for the RCM-induced immediate-type hypersensitivity reactions retrospectively. In addition, 531 subjects scheduled for CT scans using RCM were recruited prospectively and intradermal tests using the same media were performed before the scan on the test day. RESULTS: Retrospective analysis revealed that intradermal test was positive in six patients (40.0%). Interestingly, all of them had experienced severe reactions accompanied with systemic symptoms. The sensitivity of skin test was 66.6% (6/9) in the patients with severe immediate reaction. In the prospective study, five hundred and thirty subjects (99.8%) showed negative intradermal responses. Forty-three subjects (8.1%) developed immediate adverse reactions during CT scans, but all of them were mild or cutaneous reactions. One subject (0.2%) who showed positive skin response could undergo CT scan safely by switching to alternative RCM suggested by additional skin tests. CONCLUSIONS: RCM skin test had a diagnostic value in only severe immediate-type reaction. RCM skin pre-testing had a negative predictive value of 91.9%. The negative predictive value increased to nearly 100% in case of severe systemic reactions. Further large-scaled prospective study is needed, but our data suggest skin tests may be useful to rule out severe systemic adverse reactions before RCM exposure.
Angiotensin Coverting Enzyme Inhibitors: Managing drug allergic cross-reactivity P. Poza-Guedes, R. Gonzalez-Perez, V. Matheu; HUNS La Candelaria, Santa Cruz de Tenerife, SPAIN. RATIONALE: Angiotensin Coverting Enzyme Inhibitors (ACE-Is) are commonly the choice for managing hypertension. Skin adverse reacctions to ACE-Is and a possible allergic cross-reactivity among groups has not been well elucidated. METHODS: A 62 year-old lady was referred to our Unit after developing a generalized skin adverse reaction described as an ‘‘pruritic acute urticaria’’ after the intake of lisinopril that she has been taking for the last 2 years. The onset after the drug intake was 6 hours, lasting 24 hours with complete skin recovery after i.v. steroids and antihistaminics. No signs of angioedema or systemic symptoms were associated to the urticaria. RESULTS: Drug allergy work-up included epicutaneous test (Patch test) with different ACE-Is (lisinopril, captopril, enalapril and fosinopril) with negative readings at 48/96 in all cases. Skin prick test and intradermal testing (1/10) with lisinopril, captopril, enalapril and fosinopril showed negative immediate readings. Subsequently (and separate by 6 weeks each), 2 single blind placebo controlled oral challenges (SBPCOC) with increasing dosis of enalapril (20 mg) and captopril (12,5 mg) were positive developing accelerated (6hours) pruritic maculopapular urticaria in both cases. A final SBPCOC with increasing doses of fosinopril 20 mg was negative. CONCLUSION: A non-immediate skin type allergic reaction to 2 pharmacologically different structured ACE-Is (carboxylic and sulphide groups) was confirmed by SBPCOC. Interestingly a SBPCOC with a phosphoryl ACE-Is discarded allergic cross-reactivity among the 3 chemical groups and provided a safe therapeutic alternative. Further studies are currently needed to achieve a better understanding on the pathogenesis and management of this issue.
Sensitization to Penicillin in Adolescents with Rheumatic Fever M. M. R. Felix, F. C. Kuschnir, A. J. L. A. Cunha; Federal University of Rio de Janeiro, Rio de Janeiro, BRAZIL. RATIONALE: Estimate the prevalence of sensitization to penicillin among adolescents in treatment for rheumatic fever (RF). METHODS: Cross-sectional study conducted at the Center for Adolescent Health - State University of Rio de Janeiro (NESA-UERJ), Brazil, with patients between 10-19 years. Underwent a questionnaire with data about penicillin hypersensitivity, skin prick tests (SPT) with benzylpenicillin 10.000U/ml and aeroallergens (AL). The total number of injections of benzathine penicillin (TBP) was calculated. The differences in relation to gender, age and atopy among reactors (R) and non-reactors (NR) to SPT for penicillin were analyzed by c2 test and those on the TBP by Student’s t-test (significant p<0.05). Approved by the ethics committee of NESA-UERJ. RESULTS: Between Jan to Dec 2009, we evaluated 75 patients (37 females; mean age: 15.95 6 2.14 yr). Of this total, 8% were sensitive for penicillin. History of previous adverse reaction to penicillin was seen in 2 R (33%) and 2 NR (2.9%) (OR516.7;95%CI:1,85-151).There was no significant difference between R and NR in relation to gender and age. The average of TBP in R and NR were 77.2 and 107.5 respectively (p<0.001). All R had positive SPT for AL while among NR this percentage was 39.1% (OR51.42;95%CI:1,07-1,9).There were no allergic reactions to penicillin testing. CONCLUSIONS: Sensitization to penicillin was low among adolescents with RF. Atopy, history of previous reaction to penicillin and lower TBP were significantly associated with positive SPT to penicillin. Benzylpenicillin proved to be safe and able to confirm sensitization in patients with history of allergy to penicillin.