Drug Hypersensitivity in Daily Practice

ABSTRACTAdverse drug reactions can affect up to 25% of outpatients and 10–20% of hospitalized patients. They are an important public health issue due to the potential of fatal outcomes. They are increasingly common in daily practice, but ascertaining whether the adverse reaction is a true allergic reaction to the drug is not easy. Drug hypersensitivity encompasses a spectrum of immunologically and non-immunologically-mediated reactions with varying mechanisms and clinical presentations. Factors associated with an increased risk of developing a drug hypersensitivity include patient-related factors, treatment regimen-related factors, and drug-related factors.  Diagnosis of drug hypersensitivity relies on a careful history and physical examination and, in some instances, in vivo and in vitro testing and drug provocation tests. The most effective strategy for the management of drug allergy is avoidance and discontinuation of the offending drug(s). Alternative medications with unrelated chemical structures should be given. Additional therapy is largely supportive which includes nutritional support, fluid replacement, and symptomatic which may include topical corticosteroids, oral antihistamines and, in severe cases, systemic corticosteroids. This article will discuss the classification of adverse reactions to drugs, professional steps that can be taken by a physician in prescribing drugs, minimizing the risk of adverse drug reactions, approach to diagnosis, and managing drug hypersensitivity cases in daily practice.Keywords: drug reaction, drug hypersensitivity, drug allergyCorrespondence to: [email protected] ABSTRAKReaksi efek samping obat dapat mengenai sekitar 25% pasien rawat jalan dan 10-20% pasien rawat inap. Reaksi efek samping obat adalah masalah kesehatan masyarakat yang penting karena berpotensi fatal. Hal tersebut semakin umum dijumpai dalam praktek sehari-hari, tetapi memastikan apakah reaksi efek samping tersebut adalah reaksi alergi yang sebenarnya terhadap obat itu tidaklah mudah. Hipersensitivitas obat mencakup spektrum reaksi yang dimediasi secara imunologis dan non imunologis dengan berbagai mekanisme dan presentasi klinis. Faktor-faktor yang terkait dengan peningkatan risiko terjadinya hipersensitivitas obat meliputi faktor terkait pasien, faktor terkait regimen pengobatan, dan faktor terkait obat. Diagnosis hipersensitivitas obat bergantung pada anamnesis dan pemeriksaan fisik yang cermat dan, dalam beberapa kasus, tes in vivo dan in vitro dan tes provokasi obat. Strategi yang paling efektif untuk pengelolaan alergi obat adalah penghindaran dan penghentian obat-obatan tersebut. Obat-obatan alternatif dengan struktur kimia yang tidak terkait harus diberikan. Terapi terapi suportif yang mencakup dukungan nutrisi, penggantian cairan, dan gejala yang mungkin termasuk kortikosteroid topikal, antihistamin oral dan, dalam kasus yang parah, kortikosteroid sistemik dapat diberikan. Artikel ini akan membahas klasifikasi reaksi efek samping terhadap obat, langkah profesional yang dapat diambil oleh dokter dalam meresepkan obat, meminimalkan risiko reaksi efek samping obat, pendekatan untuk diagnosis, dan manajemen kasus hipersensitivitas obat dalam praktik sehari-hari.Kata kunci: Reaksi obat, hipersensitivitas obat, alergi obatKorespondensi: [email protected]

Immunotherapy for Food Allergy: Myth or Reality?

Allergic reaction to food can have serious consequences. The only treatment option is strict allergen avoidance, but accidental ingestions happen frequently and can lead to severe and potentially life-threatening allergic reactions. Food allergy is one of the most common causes of anaphylactic reactions. Therefore self-injectable epinephrine should always be at hand in case of accidental exposure. Many food allergies may resolve over time, but most patients with persistent food allergies live with fear of anaphylactic reactions. Within the last several years, the usefulness of immunotherapy for food allergies has been investigated. Several food immunotherapies are being developed; which include oral, sublingual, epicutaneous, or subcutaneous administration. The approach follows the same principles as immunotherapy for other allergic disorders, consisted of an induction phase followed by a maintenance phase with regular intake of maximum tolerated amount of food. Although immunotherapy seems promising for food allergic patients, it remains an investigational treatment that need to be studied further before advancing into clinical practice. Hopefully, multicentre and randomized-controlled studies can provide answer to multiple questions including optimal dose, ideal duration of immunotherapy, degree of protection, efficacy for different ages, severity and type of food allergy responsive to treatment. Keyword

The role of gut microbiota in health and diseases

ABSTRACTABSTRACTMicrobiota contributes a crucial part in the human hosts' health and actively provides to the emergence of various diseases. The optimal composition of healthy intestinal microbiota varies from person to person. The more various and abundant of the microbiota, the greater their resistance to outside hazards. Colonization of the microbiota in the human body starts after delivery and develops continuously from infant to adult. The largest microbial colony is constructed in the lower part of the adult human digestive tract. The composition of the human intestinal microbiota alters promptly during the beginning of life and is steady. It has been described the close relationship among dysbiosis of the intestinal microbiota with intestinal and non-intestinal diseases. Nevertheless, it is uncertain whether dysbiosis is the culprit of the disease or only as a result of the disease. Human microbiota's role must be investigated more deeply so that later it can be developed for the prevention, diagnosis of disease, and more effective treatment strategies in the future. In this minireview, we will describe the development of the gut microbiota, its interaction with our bodily systems and defense, the multiple causes of dysbiosis, and its impact on several metabolic in inflammatory diseases in humans. With this insight, it is hoped that we can be more cautious about using antibiotics, avoid things that lead to dysbiosis, and handle diseases more holistically, putting the balance of the microbiota into account. Keywords:  human, microbiota, gastrointestinal tract, dysbiosis, health and diseaseCorresponding author: [email protected]

Management of drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome in a female Indonesian with pulmonary tuberculosis: A rare case report

Background Anti-tuberculosis drugs (ATD) induced DRESS syndrome is rarely reported, and its diagnosis and management are very challenging. Case presentation A 33-year-old woman presented with fever, maculopapular rashes, hypereosinophilia, and hepatic involvement, which occurred 4 weeks after a fixed-dose combination of first-line ATD containing rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient's condition improved after the withdrawal of the drugs and administration of systemic steroids. Furthermore, active pulmonary tuberculosis was treated with second-line ATD containing streptomycin, levofloxacin, and ethambutol with no adverse reaction. Discussion Early identification of the causal drug for ATD-induced DRESS syndrome is essential, and it helps to facilitate the treatment process. In some cases, the change from first-line ATD to second-line in pulmonary tuberculosis patients with the syndrome can be considered after recovery with strict follow-up. Furthermore, the administration of systemic corticosteroids for tuberculosis treatment is still debatable, but it had positive effects in this study. Conclusion Early recognition and withdrawal of all suspected drugs are crucial in managing DRESS because the delayed diagnosis can be life-threatening. The administration of systemic steroids is effective against DRESS in pulmonary tuberculosis infection

The effects of age on antibody response towards COVID-19 vaccination: A Systematic Review

Background: Mortality rate of COVID-19 infection isexceptionally high in the older population. Various vaccines are being rapidly developed as an attempt to halt the pandemic. Although vaccination has been effective in reducing mortality and hospitalization rate in recent months, lower vaccine effectiveness has been reported among older adults.Aim: This review aims to evaluate and summarize current evidence on the effect of age on antibody response towards COVID-19 vaccines. Methods: Literature search was conducted on PubMed, Scopus, ScienceDirect and ProQuest for studies published up to 9th October 2022. The selected studies were assessed The Joanna Briggs critical appraisal tools. Qualitative analysis was then performed for the final studies.Result: A final of 9 studies were included in this review. A majority of the studies evaluated the responses of BNT162b2 or mRNA-1273 vaccine, while 1 study investigated the response towards ChAdOx1 vaccine. Outcomes were measured in term of IgG antibody levels or serum neutralization. Most studies demonstrated significantly lower antibody response and neutralization in older adults compared to younger vaccinees after administration of first and second vaccine dose. However, two studies reported no significant difference in vaccine responses across age groups after third dose administration.Conclusion: This systematic review highlights lowerimmunogenicity towards COVID-19 vaccines in older population. Further research into strategies to improve vaccine responses in the elderly is required to provide sufficient protection for this vulnerable group. Keywords: COVID-19 vaccine, antibody, neutralization, age, elderl

GENETIC AND ENVIRONMENTAL FACTORS AS STRONG DETERMINANTS OF ATOPIC ALLERGIC DISEASE CLINICAL MANIFESTATIONS IN SURABAYA'S SCHOOL CHILDREN

This case-control study was conducted to assess the relative role of genetic and environmental factors in determining the clinical manifestations of atopy allergy disease in school children, which is part of a large study of the prevalence of allergic diseases in school children in Surabaya. Using a simple multi-stage random sampling, 348 children from 5 elementary schools, 4 junior high schools, and 4 senior high schools in Surabaya were involved in the study. The subjects of the study along with her parents were guided to fill out the modified ISAAC questionnaire and underwent physical examination and skin prick test using 27 common allergen types found in the environment. For the analysis, 110 school children were randomly selected from the parent sample and included in the case group of 55 people (positive skin prick test against > 1 type of allergen), and the control group of 55 people (negative skin prick test). All genetic and environmental factors data were collected and analyzed. Most of the subjects had clinical manifestations of allergic rhinitis (66.36%), asthma (21.82%), food allergies (10.9%), and atopic dermatitis (6.36%). Complete models for multiple logistic regression analysis can only be performed for overall atopic disease and allergic rhinitis disease. The first birth order and exposure to home dust mites were the most significant clinical manifestations of atopy disease (OR 4.548, 95% CI: 1.813-11.410, p=0.01). Atopy status of the father was the only significant determinant factor for the manifestation of allergic rhinitis in the study subjects (OR 3.929; 95% CI: 1.143-13.052, p=0.03). Both genetic and environmental factors interacted and determined clinical manifestations of atopy allergy disease in school pupils. The father's genetic factors were more dominant than maternal genetic factors in determining the clinical manifestations of allergic rhinitis in offspring

EFFECT OF SEX DIFFERENCE ON THE HISTOLOGICAL STRUCTURE OF BRONCHUS AND NASAL CAVITY IN ANIMAL ASTHMA MODEL

Background: The prevalence of asthma in prepuberty women is more common than in puberty men. Even after puberty, to a certain age, women dominate more. It is still unclear whether sex hormones affect the histological structure of male and female airways. Objective: This study objective was to examine the effect of sex difference on the histological structure of bronchial and nasal cavity of mice model (Mus musculus) with ovalbumin exposure. Materials and Methods: This study used 24 mice in four groups (male control, female control, male asthma model, and female asthma model). At the sensitization phase in days 0 and 14, the mice were injected intraperitoneally with 100 μl of a mixture of 50 μl ovalbumin (200 μl/ml) and 50 μl alum. At the exposure phase in days 21 to 23, the mice were exposed to 1% ovalbumin (aerosol, 30 minutes/per day). The mice were sacrificed 48 hours after the last exposure. The data taken included four variables, bronchial epithelial thickness, bronchial smooth muscle thickness, nasal cavity goblet cells number, and nasal cavity mucosal thickness. Then, Shapiro-Wilk normality test and parametric t-test were conducted. Results: In animal asthma models, mice with male and female exposure did not cause differences in epithelial thickness and smooth muscle thickness in bronchus compared to the control group. However, there were significant differences in the number of goblet cells and mucosal thickness in nasal cavity of male and female mice compared to the control group (respectively, p= 0.002; p= 0.006 and p= 0.003; p = 0.005). There were no significant differences between groups of male and female mice on all variables. Conclusion: In animal asthma models of mice, ovalbumin exposure did not cause differences in the values of all variables between male and female groups

Comparison of total serum meningococcal-specific IgG level in the elderly and young adults after meningococcal vaccination Running head: Meningococcal vaccination in the elderly and young adults

Background: In the elderly, the immune system undergoes age-associated decline in function known as immunosenescence, which produce a progressive deterioration in the ability to fight infections and to develop immunity after vaccination. The elderly who become umrah pilgrims have a high risk of meningococcal infection. We aimed to compare total serum level of meningococcal IgG changes in the elderly and young adults before and after meningococcal MenACWYCRM197 vaccination. Methods: This study involved elderly (aged > 60) and young adult umra pilgrims in Surabaya Indonesia with a pre-post test design. MenACWY-CRM197 vaccination was done before umrah pilgrimage. Total serum meningococcal-specific IgG level was examined by ELISA before and 1 month after vaccination. The difference between groups was analyzed using independent t-test. Results: We recruited 68 subjects, consisted of 34 elderly and 34 young adult subjects. After MenACWY-CRM197 vaccination, the total serum meningococcal-specific IgG levels increased significantly in both groups (p <0.001), but changes in total serum meningococcal-specific IgG levels in the elderly was significantly lower than in young adults (p=0.001). Conclusion: Compared to young adults, the increase in total serum meningococcal-specific IgG levels after meningococcal vaccination in the elderly group were significantly lower, confirming the effect of immunosenescence