Drug Hypersensitivity
Drug Hypersensitivity Syndrome
Drug Eruptions
Stevens-Johnson Syndrome
Drug-Related Side Effects and Adverse Reactions
HLA-B Antigens
Hypersensitivity, Delayed
Anti-Inflammatory Agents, Non-Steroidal
Hypersensitivity
Alveolitis, Extrinsic Allergic
Various forms of chemically induced liver injury and their detection by diagnostic procedures. (1/1024)
A large number of chemical agents, administered for therapeutic or diagnostic purposes, can produce various types of hepatic injury by several mechanisms. Some agents are intrinsically hepatotoxic, and others produce hepatic injury only in the rare, uniquely susceptible individual. Idiosyncrasy of the host is the mechanism for most types of drug-induced hepatic injury. It may reflect allergy to the drug or a metabolic aberation of the host permitting the accumulation of hepatotoxic metabolites. The syndromes of hepatic disease produced by drugs have been classified hepatocellular, hepatocanalicular, mixed and canalicular. Measurement of serum enzyme activities has provided a powerful tool for studies of hepatotoxicity. Their measurement requires awareness of relative specificity, knowledge of the mechanisms involved, and knowledge of the relationship between known hepatotoxic states and elevated enzyme activities. (+info)Glomerular, tubular and interstitial nephritis associated with non-steroidal antiinflammatory drugs. Evidence of a common mechanism. (2/1024)
AIMS: To study the mechanisms behind NSAID-associated nephropathy. METHODS: Analysis of published case reports satisfying strict criteria for NSAID nephropathy. RESULTS: Ninety-seven cases with acute nephritis (AN; 19 patients), minimal change nephropathy (MC; 38 patients), membranous glomerulonephritis (MGN; 19 patients), focal sclerosis (FS; 13 patients) and other glomerulonephritis subgroups (8 patients) were identified. Hypersensitivity reactions were seen in all groups, most often in AN. Proteinuria was more severe in MC and FS than in MGN and unrelated to amount of glomerular deposits. The mean NSAID treatment time was 1.7 months in AN, 8.2 months in MC and 39 months in MGN and associated with amount of glomerular deposits, fusion of podocytes and proteinuria, and inversely associated with hypersensitivity, interstitial damage and renal failure. Rheumatic diseases were common in MGN. At follow-up 68 of 72 patients who had discontinued NSAID treatment had improved, 57 with normal renal function. CONCLUSIONS: NSAID nephropathy may be caused by hypersensitivity. The reaction is milder than in drug-induced acute tubulointerstitial nephritis, probably because the offending drug inhibits the inflammatory reaction it has started itself. Heavy proteinuria is probably due to lymphokines produced as a result of the immunological response. If the allergic reaction is strong, AN is produced rapidly with severe renal failure but little proteinuria; if it is less violent, immunocompetent cells may develop to produce lymphokines and proteinuria. Immune complexes may be formed eventually, secondary to the increased glomerular permeability, more easily in patients with a hyperactive immune system and with little consequence for renal function. (+info)Cellular disposition of sulphamethoxazole and its metabolites: implications for hypersensitivity. (3/1024)
1. Bioactivation of sulphamethoxazole (SMX) to chemically-reactive metabolites and subsequent protein conjugation is thought to be involved in SMX hypersensitivity. We have therefore examined the cellular metabolism, disposition and conjugation of SMX and its metabolites in vitro. 2. Flow cytometry revealed binding of N-hydroxy (SMX-NHOH) and nitroso (SMX-NO) metabolites of SMX, but not of SMX itself, to the surface of viable white blood cells. Cellular haptenation by SMX-NO was reduced by exogenous glutathione (GSH). 3. SMX-NHOH and SMX-NO were rapidly reduced back to the parent compound by cysteine (CYS), GSH, human peripheral blood cells and plasma, suggesting that this is an important and ubiquitous bioinactivation mechanism. 4. Fluorescence HPLC showed that SMX-NHOH and SMX-NO depleted CYS and GSH in buffer, and to a lesser extent, in cells and plasma. 5. Neutrophil apoptosis and inhibition of neutrophil function were induced at lower concentrations of SMX-NHOH and SMX-NO than those inducing loss of membrane viability, with SMX having no effect. Lymphocytes were significantly (P<0.05) more sensitive to the direct cytotoxic effects of SMX-NO than neutrophils. 6. Partitioning of SMX-NHOH into red blood cells was significantly (P<0.05) lower than with the hydroxylamine of dapsone. 7. Our results suggest that the balance between oxidation of SMX to its toxic metabolites and their reduction is an important protective cellular mechanism. If an imbalance exists, haptenation of the toxic metabolites to bodily proteins including the surface of viable cells can occur, and may result in drug hypersensitivity. (+info)Evidence of anaphylaxy after alteplase infusion. (4/1024)
BACKGROUND AND PURPOSE: Although alteplase, a recombinant tissue plasminogen activator (tPA), is structurally identical to endogenous tPA and therefore should not induce allergy, single cases of acute hypersensitivity reactions have been reported. Until now, specific antibodies against alteplase were not detected in blood samples obtained in these patients. CASE DESCRIPTION: We report an anaphylactic reaction in a 70-year-old white female who was treated with intravenous alteplase for thrombolysis of acute ischemic stroke 160 minutes after onset of a right-sided hemiparesis. Thirty minutes after infusion of alteplase had been started, the patient suffered acute severe sinus tachycardia and hypotension, followed by cyanosis and loss of consciousness. The alteplase infusion was stopped, and following antiallergic therapy, tachycardia and hypotension resolved within 1 hour. The hemiparesis remained unaltered, but additional harm resulting from the hemodynamic complication was not observed. Serum samples analyzed with a radioimmunoprecipitation assay were negative for total antibodies to alteplase, but in a subsequent ELISA, both samples were positive for IgE antibodies to alteplase. CONCLUSIONS: The detection of specific IgE antibodies reactive with alteplase in this patient could provide the first evidence of an anaphylactic-type reaction to alteplase in man. Because previous exposure to alteplase can be excluded, the results suggest that this patient had preexisting antibodies that were cross-reactive with one or more epitopes of alteplase and therefore precipitated the anaphylactic-type reaction. (+info)Successful treatment with gabapentin in the presence of hypersensitivity syndrome to phenytoin and carbamazepine: a report of three cases. (5/1024)
We report three consecutive patients with hypersensitivity syndrome (HSS) due to phenytoin and carbamazepine and successful treatment with gabapentin. HSS is a rare but potentially fatal reaction to multiple drugs including several anticonvulsants. Cross-reactivity among drugs may occur. Immediate withdrawal of the offending drug is the most important step in treatment. Benzodiazepines acutely and, after resolution of the hepatitis, valproic acid have been successfully used for seizure control in patients with HSS. Our cases indicate that gabapentin is also a safe anticonvulsant in HSS. (+info)Highly Th2-skewed cytokine profile of beta-lactam-specific T cells from nonatopic subjects with adverse drug reactions. (6/1024)
A positive lymphocyte transformation test to beta-lactams (beta-L) was found in 12 of 29 subjects with adverse drug reaction (ADR) to beta-L, irrespective of either the type of clinical manifestation or the presence of specific serum IgE. Short-term T cell lines specific for penicillin G, amoxicillin, and ampicillin could be generated only from subjects with ADR (eight with positive and one with negative lymphocyte transformation test), while streptokinase and Dermatophagoides pteronyssinus group 1 (Der p 1)-specific T cells were obtained from all these subjects, from 7 atopic Der p-sensitive donors without history of ADR and 17 healthy nonatopic donors. Streptokinase-specific T cells from all subjects showed intracellular expression of IFN-gamma with poor or no IL-4, whereas Der p 1-specific T cells exhibited IFN-gamma but low or no IL-4 expression in nonatopics, and remarkable IL-4 expression in atopic donors. By contrast, all penicillin G-, ampicillin-, and amoxicillin-specific short-term T cell lines showed high intracellular expression of IL-4, IL-5, and IL-13, but poor or no expression of IFN-gamma, thus exhibiting a clear-cut Th2 profile. Accordingly, most penicillin G-specific T cell clones derived from two subjects with ADR released high concentrations of IL-4 alone or IL-4 and IFN-gamma. These data suggest that cytokines produced by Th2 cells play an important role in all beta-L-induced ADR, even when late clinical manifestations occur and an IgE-mediated mechanism is apparently indemonstrable. (+info)Prevention of occupational allergy caused by exposure to acid anhydrides. (7/1024)
This paper focuses on the prevention of IgE-mediated symptoms of the eyes and airways caused by exposure to acid anhydrides in the workplace. Acid anhydrides are widely used in the production of alkyd resins and as curing agents for epoxy resins. Heavy exposure to acid anhydrides causes severe irritation. However, reports of direct irritation of mucous membranes or skin are rare in recent years, since a package of multiple engineering controls has been introduced to reduce exposure. On the other hand, acid anhydrides are well-known industrial inhalant sensitizers and can cause occupational allergy even at very low exposure intensities. Therefore, safe use in industry demands both control of the level of exposure causing allergic diseases in the workshop and programmes for prevention of occupational allergy. (+info)20 years of medical surveillance on exposure to allergenic and non-allergenic platinum compounds: the importance of chemical speciation. (8/1024)
OBJECTIVES: Chloroplatinates are potent allergens but other soluble platinum compounds such as tetraammine platinum dichloride (TPC) do not provoke reactions in subjects who are sensitive to chloroplatinates. TPC has been used in the manufacture of autocatalysts for 20 years. This study analyses 20 year data on exposure to soluble platinum compounds and medical surveillance to confirm that TPC is not allergenic. METHODS: Workers in three distinct operations were exposed to soluble platinum compounds as chloroplatinates, chloroplatinates with TPC, or to TPC alone. Results of personal air sampling for soluble platinum compounds were compared together with the results of medical surveillance. RESULTS: The levels of exposure to soluble platinum compounds in each operation were comparable but the incidence of allergy was significantly different. In a subgroup of workers consistently exposed to chemical processes in each operation, the cumulative chance of being sensitised after 5 years of exposure was estimated as 51% for chloroplatinate exposure, 33% for mixed exposure, and 0% for TPC alone. The differences in sensitisation rates could not be explained by age, sex, and atopy. Nor could they be explained by the increased frequency of smoking in the workers with chloroplatinate exposure, despite the markedly higher risk of sensitisation in smokers. The differences could only be explained by the chemical stability of TPC. CONCLUSIONS: This study shows that the soluble platinum compound TPC is not allergenic under normal industrial conditions. Characterisation of the chemical compound (speciation) is essential to prevent stringent exposure limits being imposed for all soluble compounds on a generic basis. (+info)Drug hypersensitivity is an abnormal immune response to a medication or its metabolites. It is a type of adverse drug reaction that occurs in susceptible individuals, characterized by the activation of the immune system leading to inflammation and tissue damage. This reaction can range from mild symptoms such as skin rashes, hives, and itching to more severe reactions like anaphylaxis, which can be life-threatening.
Drug hypersensitivity reactions can be classified into two main types: immediate (or IgE-mediated) and delayed (or non-IgE-mediated). Immediate reactions occur within minutes to a few hours after taking the medication and are mediated by the release of histamine and other inflammatory mediators from mast cells and basophils. Delayed reactions, on the other hand, can take several days to develop and are caused by T-cell activation and subsequent cytokine release.
Common drugs that can cause hypersensitivity reactions include antibiotics (such as penicillins and sulfonamides), nonsteroidal anti-inflammatory drugs (NSAIDs), monoclonal antibodies, and chemotherapeutic agents. It is important to note that previous exposure to a medication does not always guarantee the development of hypersensitivity reactions, as they can also occur after the first administration in some cases.
The diagnosis of drug hypersensitivity involves a thorough medical history, physical examination, and sometimes skin or laboratory tests. Treatment typically includes avoiding the offending medication and managing symptoms with antihistamines, corticosteroids, or other medications as needed. In severe cases, emergency medical care may be required to treat anaphylaxis or other life-threatening reactions.
Drug Hypersensitivity Syndrome (DHS), also known as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), is a severe adverse drug reaction that can affect multiple organ systems in the body. It is characterized by a combination of skin rash, fever, lymph node enlargement, and internal organ involvement, such as hepatitis, nephritis, pneumonitis, or myocarditis.
The syndrome typically occurs within 2 to 6 weeks after starting a medication, but it can occur even several months later. The most commonly implicated drugs are aromatic anticonvulsants (e.g., carbamazepine, phenytoin, and phenobarbital), sulfonamides, dapsone, allopurinol, and abacavir.
The exact mechanism of DHS is not fully understood, but it is believed to involve an immune-mediated reaction, possibly triggered by a genetic predisposition or altered drug metabolism. The diagnosis of DHS is based on clinical criteria, including the presence of skin rash, fever, lymphadenopathy, and internal organ involvement, as well as laboratory abnormalities such as eosinophilia and atypical lymphocytosis.
Treatment of DHS typically involves discontinuation of the offending drug, supportive care, and management of specific organ involvement. Corticosteroids are often used to suppress the immune response and reduce inflammation, but their efficacy is not well established. The prognosis of DHS varies depending on the severity of organ involvement and the timeliness of appropriate treatment.
A "drug eruption" is a general term used to describe an adverse skin reaction that occurs as a result of taking a medication. These reactions can vary in severity and appearance, and may include symptoms such as rash, hives, itching, redness, blistering, or peeling of the skin. In some cases, drug eruptions can also cause systemic symptoms such as fever, fatigue, or joint pain.
The exact mechanism by which drugs cause eruptions is not fully understood, but it is thought to involve an abnormal immune response to the medication. There are many different types of drug eruptions, including morphilliform rashes, urticaria (hives), fixed drug eruptions, and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), which is a severe and potentially life-threatening reaction.
If you suspect that you are experiencing a drug eruption, it is important to seek medical attention promptly. Your healthcare provider can help determine the cause of the reaction and recommend appropriate treatment. In some cases, it may be necessary to discontinue the medication causing the reaction and switch to an alternative therapy.
Stevens-Johnson Syndrome (SJS) is a rare, serious and potentially life-threatening skin reaction that usually occurs as a reaction to medication but can also be caused by an infection. SJS is characterized by the detachment of the epidermis (top layer of the skin) from the dermis (the layer underneath). It primarily affects the mucous membranes, such as those lining the eyes, mouth, throat, and genitals, causing painful raw areas that are prone to infection.
SJS is considered a severe form of erythema multiforme (EM), another skin condition, but it's much more serious and can be fatal. The symptoms of SJS include flu-like symptoms such as fever, sore throat, and fatigue, followed by a red or purplish rash that spreads and blisters, eventually leading to the detachment of the top layer of skin.
The exact cause of Stevens-Johnson Syndrome is not always known, but it's often triggered by medications such as antibiotics, anti-convulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antiretroviral drugs. Infections caused by herpes simplex virus or Mycoplasma pneumoniae can also trigger SJS.
Treatment for Stevens-Johnson Syndrome typically involves hospitalization, supportive care, wound care, and medication to manage pain and prevent infection. Discontinuing the offending medication is crucial in managing this condition. In severe cases, patients may require treatment in a burn unit or intensive care unit.
Drug-related side effects and adverse reactions refer to any unintended or harmful outcome that occurs during the use of a medication. These reactions can be mild or severe and may include predictable, known responses (side effects) as well as unexpected, idiosyncratic reactions (adverse effects). Side effects are typically related to the pharmacologic properties of the drug and occur at therapeutic doses, while adverse reactions may result from allergic or hypersensitivity reactions, overdoses, or interactions with other medications or substances.
Side effects are often dose-dependent and can be managed by adjusting the dose, frequency, or route of administration. Adverse reactions, on the other hand, may require discontinuation of the medication or treatment with antidotes or supportive care. It is important for healthcare providers to monitor patients closely for any signs of drug-related side effects and adverse reactions and to take appropriate action when necessary.
HLA-B antigens are human leukocyte antigen (HLA) proteins found on the surface of cells that play an important role in the body's immune system. They are part of the major histocompatibility complex (MHC) class I molecules, which present pieces of proteins from inside the cell to T-cells, a type of white blood cell involved in immune responses.
HLA-B antigens are highly polymorphic, meaning that there are many different variations or alleles of this gene in the human population. This genetic diversity allows for a wide range of potential HLA-B proteins to be expressed, which can help recognize and respond to a variety of foreign substances, such as viruses and cancer cells.
The HLA-B antigens are inherited from both parents, and an individual may express one or two different HLA-B antigens depending on their genetic makeup. The specific combination of HLA-B antigens that a person expresses can have implications for their susceptibility to certain diseases, as well as their compatibility with organ transplants.
Delayed hypersensitivity, also known as type IV hypersensitivity, is a type of immune response that takes place several hours to days after exposure to an antigen. It is characterized by the activation of T cells (a type of white blood cell) and the release of various chemical mediators, leading to inflammation and tissue damage. This reaction is typically associated with chronic inflammatory diseases, such as contact dermatitis, granulomatous disorders (e.g. tuberculosis), and certain autoimmune diseases.
The reaction process involves the following steps:
1. Sensitization: The first time an individual is exposed to an antigen, T cells are activated and become sensitized to it. This process can take several days.
2. Memory: Some of the activated T cells differentiate into memory T cells, which remain in the body and are ready to respond quickly if the same antigen is encountered again.
3. Effector phase: Upon subsequent exposure to the antigen, the memory T cells become activated and release cytokines, which recruit other immune cells (e.g. macrophages) to the site of inflammation. These cells cause tissue damage through various mechanisms, such as phagocytosis, degranulation, and the release of reactive oxygen species.
4. Chronic inflammation: The ongoing immune response can lead to chronic inflammation, which may result in tissue destruction and fibrosis (scarring).
Examples of conditions associated with delayed hypersensitivity include:
* Contact dermatitis (e.g. poison ivy, nickel allergy)
* Tuberculosis
* Leprosy
* Sarcoidosis
* Rheumatoid arthritis
* Type 1 diabetes mellitus
* Multiple sclerosis
* Inflammatory bowel disease (e.g. Crohn's disease, ulcerative colitis)
Non-steroidal anti-inflammatory agents (NSAIDs) are a class of medications that reduce pain, inflammation, and fever. They work by inhibiting the activity of cyclooxygenase (COX) enzymes, which are involved in the production of prostaglandins, chemicals that contribute to inflammation and cause blood vessels to dilate and become more permeable, leading to symptoms such as pain, redness, warmth, and swelling.
NSAIDs are commonly used to treat a variety of conditions, including arthritis, muscle strains and sprains, menstrual cramps, headaches, and fever. Some examples of NSAIDs include aspirin, ibuprofen, naproxen, and celecoxib.
While NSAIDs are generally safe and effective when used as directed, they can have side effects, particularly when taken in large doses or for long periods of time. Common side effects include stomach ulcers, gastrointestinal bleeding, and increased risk of heart attack and stroke. It is important to follow the recommended dosage and consult with a healthcare provider if you have any concerns about using NSAIDs.
A syndrome, in medical terms, is a set of symptoms that collectively indicate or characterize a disease, disorder, or underlying pathological process. It's essentially a collection of signs and/or symptoms that frequently occur together and can suggest a particular cause or condition, even though the exact physiological mechanisms might not be fully understood.
For example, Down syndrome is characterized by specific physical features, cognitive delays, and other developmental issues resulting from an extra copy of chromosome 21. Similarly, metabolic syndromes like diabetes mellitus type 2 involve a group of risk factors such as obesity, high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that collectively increase the risk of heart disease, stroke, and diabetes.
It's important to note that a syndrome is not a specific diagnosis; rather, it's a pattern of symptoms that can help guide further diagnostic evaluation and management.
Hypersensitivity is an exaggerated or inappropriate immune response to a substance that is generally harmless to most people. It's also known as an allergic reaction. This abnormal response can be caused by various types of immunological mechanisms, including antibody-mediated reactions (types I, II, and III) and cell-mediated reactions (type IV). The severity of the hypersensitivity reaction can range from mild discomfort to life-threatening conditions. Common examples of hypersensitivity reactions include allergic rhinitis, asthma, atopic dermatitis, food allergies, and anaphylaxis.
Extrinsic allergic alveolitis is a type of lung inflammation that occurs in response to inhaling organic dusts or mold spores that contain allergens. It is also known as hypersensitivity pneumonitis. This condition typically affects people who have been repeatedly exposed to the allergen over a period of time, such as farmers, bird fanciers, and workers in certain industries.
The symptoms of extrinsic allergic alveolitis can vary but often include cough, shortness of breath, fever, and fatigue. These symptoms may develop gradually or suddenly, depending on the frequency and intensity of exposure to the allergen. In some cases, the condition may progress to cause permanent lung damage if it is not treated promptly.
Diagnosis of extrinsic allergic alveolitis typically involves a combination of medical history, physical examination, imaging studies such as chest X-rays or CT scans, and pulmonary function tests. In some cases, blood tests or bronchoscopy with lavage may also be used to help confirm the diagnosis.
Treatment for extrinsic allergic alveolitis typically involves avoiding further exposure to the allergen, as well as using medications such as corticosteroids to reduce inflammation and relieve symptoms. In severe cases, hospitalization and oxygen therapy may be necessary. With prompt and appropriate treatment, most people with extrinsic allergic alveolitis can recover fully and avoid long-term lung damage.