31 research outputs found
Allergic Reactions to Metamizole: Immediate and Delayed Responses
[EN] Background: Pyrazolones are the most common causes of
selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity.
We studied a large group of patients with immediate
and delayed selective responses to metamizole.
Methods: Patients with suspicion of hypersensitivity to metamizole
were evaluated. We verified acetylsalicylic acid tolerance
and classified patients as immediate or delayed responders
if they showed symptoms less or more than 24 h
after metamizole administration. Skin tests were performed
and if negative, a basophil activation test (BAT) was performed
on immediate responders. If it was negative, we performed
a drug provocation test (DPT) with metamizole. Results:
A total of 137 patients were included: 132 reacted
within 24 h (single NSAID-induced urticaria/angioedema/
anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced
delayed hypersensitivity reaction; SNIDHR). Most SNIUAA
patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular
exanthema was the most frequent entity (60%).
Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1%
of the cases, DPT with metamizole was needed to establish
the diagnosis. In 22.62% of the cases, diagnosis was established
by consistent and unequivocal history of repeated allergic
episodes in spite of a negative skin test and BAT. Conclusions:
SNIUAA to metamizole is the most frequent type of
selective NSAID hypersensitivity, with anaphylaxis being the
most common clinical entity. It may occur within 1 h after
drug intake. SNIDHR occurs in a very low percentage of cases.
The low sensitivity of diagnostic tests may be due to incomplete
characterization of the chemical structures of metamizole
and its metabolites.The present study has been supported by the Institute of Health âCarlos IIIâ of the Ministry of Economy and Competitiveness [grants cofounded by European Regional Development Fund (ERDF), Red de Reacciones Adversas a Alergenos y Farmacos (RD12/0013/0001 and PI15/01317)] and by Consejeria de Salud de la Junta de AndalucĂa (PI-0463-2013).Blanca-LĂłpez, N.; PĂ©rez-Sanchez, N.; AgĂșndez, JA.; GarcĂa-MartĂn, E.; Torres, MJ.; Cornejo-Garcia, JA.; Perkins, JR.... (2016). Allergic Reactions to Metamizole: Immediate and Delayed Responses. International Archives of Allergy and Immunology. 169(4):223-230. https://doi.org/10.1159/000444798S223230169
Asthma and rhinitis induced by selective immediate reactions to paracetamol and non-steroidal anti-inflammatory drugs in aspirin tolerant subjects
En sujetos con anti-inflamatorios no esteroideos (AINES) se agravan las enfermedades respiratorias (ERNE) y los sĂntomas son desencadenados por el ĂĄcido acetilsalicĂlico (AAS) y otros potentes inhibidores COX-1 y, en algunos casos, por la debilidad de la COX-1 o los inhibidores selectivos de la COX-2. El mecanismo estĂĄ relacionado con la prostaglandina vĂa inhibiciĂłn y la liberaciĂłn de leucotrienos. Los sujetos que reaccionan a un solo AINES y toleran otros se consideran respondedores selectivos, y a menudo presentan urticaria y/o angioedema y anafilaxia (SNIUAA). Un mecanismo inmunolĂłgico estĂĄ implicado en estas reacciones. Sin embargo, la evidencia anecdĂłtica sugiere que los respondedores selectivos que presentan sĂntomas de las vĂas respiratorias tambiĂ©n pueden existir en los sĂntomas respiratorios. Nuestro objetivo fue determinar si los sujetos pueden desarrollar respuestas selectivas a los AINES/paracetamol que se manifiestan como vĂas respiratorias superiores/inferiores de los sĂntomas respiratorios. Para ello, estudiamos informes de pacientes con rinitis y/o asma inducida por el paracetamol o un Ășnico NSAID que tolera la ASA. Una evaluaciĂłn alergolĂłgica plus reto, controlados con ASA, se llevĂł a cabo. Si la tolerancia ASA se encuentra, se procede a una provocaciĂłn oral con el fĂĄrmaco responsable. La apariciĂłn de los sĂntomas fue supervisada por un cuestionario clĂnico, midiendo el FEV1 y/o las vĂas respiratorias nasales y los cambios de volumen pre y post-desafĂo. De un total de 21 casos iniciales, hemos confirmado la apariciĂłn de problemas nasales y/o manifestaciones bronquiales en diez, caracterizados por una disminuciĂłn significativa en el VEF1% y/o una disminuciĂłn en el volumen de la cavidad nasal tras la administraciĂłn del fĂĄrmaco. Todos los casos tolerados cuentan con ASA. Esto demuestra que los sujetos con tolerante ASA presentan manifestaciones sistĂ©micas de rinitis y/o asma inducida por el paracetamol o un Ășnico NSAID sin piel. Se requiere mĂĄs investigaciĂłn para saber si estos pacientes representan un nuevo fenotipo clĂnico para ser incluido dentro de la actual clasificaciĂłn de las reacciones de hipersensibilidad a AINES.In subjects with non-steroidal anti-inflammatory drugs (NSAIDs)- exacerbated respiratory disease (NERD) symptoms are triggered by acetyl salicylic acid (ASA) and other strong COX-1 inhibitors, and in some cases by weak COX-1 or by selective COX-2 inhibitors. The mechanism involved is related to prostaglandin pathway inhibition and leukotriene release. Subjects who react to a single NSAID and tolerate others are considered selective responders, and often present urticaria and/or angioedema and anaphylaxis (SNIUAA). An immunological mechanism is implicated in these reactions. However, anecdotal evidence suggests that selective responders who present respiratory airway symptoms may also exist. Our objective was to determine if subjects might develop selective responses to NSAIDs/paracetamol that manifest as upper/lower airways respiratory symptoms. For this purpose, we studied patients reporting asthma and/or rhinitis induced by paracetamol or a single NSAID that tolerated ASA. An allergological evaluation plus controlled challenge with ASA was carried out. If ASA tolerance was found, we proceeded with an oral challenge with the culprit drug. The appearance of symptoms was monitored by a clinical questionnaire and by measuring FEV1 and/or nasal airways volume changes pre and post challenge. From a total of 21 initial cases, we confirmed the appearance of nasal and/or bronchial manifestations in ten, characterized by a significant decrease in FEV1% and/or a decrease in nasal volume cavity after drug administration. All cases tolerated ASA. This shows that ASA tolerant subjects with asthma and/or rhinitis induced by paracetamol or a single NSAID without skin/systemic manifestations exist. Whether these patients represent a new clinical phenotype to be included within the current classification of hypersensitivity reactions to NSAIDs requires further investigation.Trabajo patrocinado por:
Programa Miguel Servet. Ref CP14/00034, para JosĂ© Antonio Cornejo GarcĂa
Ministerio de EconomĂa y Competitividad y Instituto Nacional de Salud Carlos III y Fondos FEDER. Programa Sara Borrell. Ref. CD14/00242, para James R. Perkins
Ministerio de EconomĂa y Competitividad e Instituto Nacional de Salud Carlos III y Fondos FEDER. Becas FISPI12/02247, FISPI13/02598, FISPI15/00726 y FIS PI15/00303
Servicio PĂșblico de Salud de AndalucĂa. Becas PI-0279-2012 y PI-0463- 2013
Junta de Extremadura y Fondos FEDER. Beca GR15026peerReviewe
Guia inovador de feedback para docentes de prĂĄticas clĂnicas em enfermagem: criando pontes de aprendizado
The study elucidates the pivotal role of effective feedback in nursing studentsâ learning and professional development, emphasizing the integrated pedagogical techniques employed by clinical instructors. In 2023, an educational innovation was implemented at the University of Las Americas, VinÌa del Mar, with the objective of enhancing instructorsâ proficiency in delivering effective feedback during integrated practices. This initiative involved identifying their self-perceptions and capabilities, followed by the design and deployment of a specialized training program. Following the training, a notable enhancement in the teachersâ feedback delivery was observed, with scores surpassing 75 % on the Direct Assessment of Clinical Skills Scale. Additionally, an increase was noted in teacher satisfaction surveys, particularly in aspects related to feedback. This positive trajectory in scores underscores the significant impact of focused teacher training on feedback mechanisms, affirming the potential to enhance educational experiences and outcomes by strengthening instructor competencies in feedback delivery within clinical practice contexts.El presente estudio pone de manifiesto el rol crucial de la retroalimentacioÌn efectiva en el aprendizaje y desarrollo profesional de los estudiantes de enfermeriÌa, siendo las teÌcnicas pedagoÌgicas integradas por los instructores cliÌnicos un componente fundamental. En 2023, se implementoÌ una innovacioÌn educativa en la Universidad de Las AmeÌricas, VinÌa del Mar, con el objetivo de mejorar la competencia de los instructores para proporcionar retroalimentacioÌn efectiva durante las praÌcticas integradas. Esto involucroÌ identificar sus autopercepciones y capacidades, seguido del disenÌo y aplicacioÌn de un programa de capacitacioÌn especializado que resultoÌ en la formulacioÌn de una guiÌa de retroalimentacioÌn efectiva. DespueÌs de la capacitacioÌn, se observoÌ una mejora notable en la entrega de retroalimentacioÌn por parte de los docentes, con puntuaciones superiores al 75 % en la escala de evaluacioÌn directa de habilidades cliÌnicas. AdemaÌs, se notoÌ un aumento en las encuestas de satisfaccioÌn docente, particularmente, en aspectos relacionados con la retroalimentacioÌn. La trayectoria ascendente en las puntuaciones subraya el impacto positivo pronunciado de la capacitacioÌn docente focalizada en mecanismos de retroalimentacioÌn, lo que confirma el potencial para elevar las experiencias y resultados educativos al fortalecer las competencias del instructor en la entrega de retroalimentacioÌn de los contextos de praÌctica cliÌnica.O presente estudo destaca o papel crucial do feedback efetivo na aprendizagem e no desenvolvimento profissional dos estudantes de enfermagem, sendo as teÌcnicas pedagoÌgicas integradas pelos instrutores cliÌnicos um componente fundamental. Em 2023, foi implementada uma inovaçaÌo educativa na Universidade de Las AmeÌricas, VinÌa del Mar, com o objetivo de melhorar a competeÌncia dos instrutores para fornecer feedback efetivo durante as praÌticas integradas. Isso envolveu identificar suas autopercepçoÌes e capacidades, seguido da formulaçaÌo e aplicaçaÌo de um programa de capacitaçaÌo especializado que resultou na formulaçaÌo de um guia de feedback efetivo. ApoÌs a capacitaçaÌo, observou-se uma melhora notaÌvel na entrega de feedback por parte dos docentes, com pontuaçoÌes superiores a 75 % na escala de avaliaçaÌo direta de habilidades cliÌnicas. AleÌm disso, notou-se um aumento nas pesquisas de satisfaçaÌo docente, particularmente, nos aspectos relacionados ao feedback. A trajetoÌria ascendente nas pontuaçoÌes destaca o impacto positivo pronunciado da capacitaçaÌo docente focada em mecanismos de feedback, confirmando o potencial para elevar as experieÌncias e resultados educativos ao fortalecer as competeÌncias do instrutor na entrega de feedback nos contextos de praÌtica cliÌnica
Identification of Novel Biomarkers for Drug Hypersensitivity After Sequencing of the Promoter Area in 16 Genes of the Vitamin D Pathway and the High-Affinity IgE Receptor.
The prevalence of allergic diseases and drug hypersensitivity reactions (DHRs) during recent years is increasing. Both, allergic diseases and DHRs seem to be related to an interplay between environmental factors and genetic susceptibility. In recent years, a large effort in the elucidation of the genetic mechanisms involved in these disorders has been made, mostly based on case-control studies, and typically focusing on isolated SNPs. These studies provide a limited amount of information, which now can be greatly expanded by the complete coverage that Next Generation Sequencing techniques offer. In this study, we analyzed the promoters of sixteen genes related to the Vitamin D pathway and the high-affinity IgE receptor, including FCER1A, MS4A2, FCER1G, VDR, GC, CYP2R1, CYP27A1, CYP27B1, CYP24A1, RXRA, RXRB, RXRG, IL4, IL4R, IL13, and IL13RA1. The study group was composed of patients with allergic rhinitis plus asthma (AR+A), patients with hypersensitivity to beta-lactams (BLs), to NSAIDs including selective hypersensitivity (SH) and cross-reactivity (CR), and healthy controls without antecedents of atopy or adverse drug reactions. We identified 148 gene variations, 43 of which were novel. Multinomial analyses revealed that three SNPs corresponding to the genes FCER1G (rs36233990 and rs2070901), and GC (rs3733359), displayed significant associations and, therefore, were selected for a combined dataset study in a cohort of 2,476 individuals. The strongest association was found with the promoter FCER1G rs36233990 SNP that alters a transcription factor binding site. This SNP was over-represented among AR+A patients and among patients with IgE-mediated diseases, as compared with control individuals or with the rest of patients in this study. Classification models based on the above-mentioned SNPs were able to predict correct clinical group allocations in patients with DHRs, and patients with IgE-mediated DHRs. Our findings reveal gene promoter SNPs that are significant predictors of drug hypersensitivity, thus reinforcing the hypothesis of a genetic predisposition for these diseases
Allergic Reactions to Metamizole: Immediate and Delayed Responses.
Pyrazolones are the most common causes of selective nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity. We studied a large group of patients with immediate and delayed selective responses to metamizole. Patients with suspicion of hypersensitivity to metamizole were evaluated. We verified acetylsalicylic acid tolerance and classified patients as immediate or delayed responders if they showed symptoms less or more than 24 h after metamizole administration. Skin tests were performed and if negative, a basophil activation test (BAT) was performed on immediate responders. If it was negative, we performed a drug provocation test (DPT) with metamizole. A total of 137 patients were included: 132 reacted within 24 h (single NSAID-induced urticaria/angioedema/anaphylaxis; SNIUAA) and 5 after 24 h (single NSAID-induced delayed hypersensitivity reaction; SNIDHR). Most SNIUAA patients developed anaphylaxis (60.60%); for SNIDHR, maculopapular exanthema was the most frequent entity (60%). Skin testing was positive in 62.04% of all cases and BAT in 28% of the SNIUAA patients with negative skin tests. In 5.1% of the cases, DPT with metamizole was needed to establish the diagnosis. In 22.62% of the cases, diagnosis was established by consistent and unequivocal history of repeated allergic episodes in spite of a negative skin test and BAT. SNIUAA to metamizole is the most frequent type of selective NSAID hypersensitivity, with anaphylaxis being the most common clinical entity. It may occur within 1 h after drug intake. SNIDHR occurs in a very low percentage of cases. The low sensitivity of diagnostic tests may be due to incomplete characterization of the chemical structures of metamizole and its metabolites
The Diamine Oxidase Gene Is Associated with Hypersensitivity Response to Non-Steroidal Anti-Inflammatory Drugs
<div><p>Non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in hypersensitivity drug reactions. Histamine is released in the allergic response to NSAIDs and is responsible for some of the clinical symptoms. The aim of this study is to analyze clinical association of functional polymorphisms in the genes coding for enzymes involved in histamine homeostasis with hypersensitivity response to NSAIDs. We studied a cohort of 442 unrelated Caucasian patients with hypersensitivity to NSAIDs. Patients who experienced three or more episodes with two or more different NSAIDs were included. If this requirement was not met diagnosis was established by challenge. A total of 414 healthy unrelated controls ethnically matched with patients and from the same geographic area were recruited. Analyses of the SNPs rs17740607, rs2073440, rs1801105, rs2052129, rs10156191, rs1049742 and rs1049793 in the <em>HDC</em>, <em>HNMT</em> and <em>DAO</em> genes were carried out by means of TaqMan assays. The detrimental DAO 16 Met allele (rs10156191), which causes decreased metabolic capacity, is overrepresented among patients with crossed-hypersensitivity to NSAIDs with an OR â=â1.7 (95% CI â=â1.3â2.1; Pc â=â0.0003) with a gene-dose effect (Pâ=â0.0001). The association was replicated in two populations from different geographic areas (Pc â=â0.008 and Pc â=â0.004, respectively).</p> <h3>Conclusions and implications</h3><p>The <em>DAO</em> polymorphism rs10156191 which causes impaired metabolism of circulating histamine is associated with the clinical response in crossed-hypersensitivity to NSAIDs and could be used as a biomarker of response.</p> </div