The drug ambassador project: the diversity of diagnostic procedures for drug allergy around Europe

Background: Drug allergy is an increasingly important clinical problem. About 5-10% of patients consulting allergy centers have some form of drug allergy or pseudo allergy. At present there is no consensus concerning the best way to study and diagnose hypersensitivity reactions to drugs. This leads both to practical difficulties in diagnosing individual patients and to more general problems in comparing protocols and results from different centers. Methods/Data base: The European Network for Drug Allergy (ENDA) Drug Ambassador Project aimed to collect information on the ways that different European centers approach these patients. Results: The present report summarizes data collected during this project, focussing on the organization of drug allergy consultations, diagnostic protocols and the various in vitro and in vivo investigation procedures in current use. The study revealed wide variation in the diagnostic procedures used for drug allergy in clinical practice, despite the apparent consensus achieved in recommendations and position papers. Conclusion: Reciprocal exchange of information and discussions based on these observations may help to achieve standardization and harmonization in this sector with significant potential benefits for patients with drug allergies

MOESM1 of Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study

Additional file 1. Effectiveness of icatibant for treatment of hereditary angioedema attacks is not affected by body weight: findings from the Icatibant Outcome Survey, a cohort observational study

Available time-to-event data for patients with HAE types I and II.^†

<p>^†For each attack experienced by patients in the IOS database, data were collected for time to first injection (time between start of the attack and icatibant first injection [n = 235 attacks]), time to resolution (time between icatibant first injection and complete resolution of symptoms [n = 241 attacks]) and duration of attack (time between start of the attack and complete resolution of symptoms [n = 220 attacks]).</p

Early treatment with icatibant and mean attack duration by attack location.

<p>Early treatment with icatibant and mean attack duration by attack location.</p

Concomitant and/or rescue medication taken by the patient for the attack.

†<p>Patients could be counted in more than one category.</p>‡<p>Two patients were receiving long-term prophylaxis. For the remaining 16 patients, it is unknown whether they were using C1-INH concentrate as long-term prophylaxis or as rescue medication.</p

Self-administration of icatibant resulted in earlier treatment.

<p>Figure shows proportion of patients treated before and after each timepoint n = 72 for HCP-administered patients, n = 158 for self-administered patients. All patients are included at each timepoint; *** <i>p</i> = 0.001 for self-administration versus HCP-administration,*<i>p</i> = 0.016 for self-administration versus HCP-administration, NS, not significant; HCP, healthcare professional; SA, self-administration.</p

Patient demographics.

†<p>Other includes the total number of patients in the following categories: Other, n = 5; Caucasian and oriental, n = 1; Hispanic, n = 1; Jewish, n = 1; Mixed race, n = 1; South American, n = 1.</p

Very early treatment with icatibant reduced mean time to resolution. Figure demonstrates the mean time to resolution (time between first injection and complete resolution of symptoms) of attacks treated before and after each timepoint.

<p>n = 207 attacks (<1 hour, n = 80; ≥1 hour, n = 127; <2 hours, n = 120; ≥2 hours, n = 87; <5 hours, n = 145; ≥5 hours, n = 62); all attacks are included at each timepoint; *<i>p</i> = 0.033, NS, not significant.</p

Early treatment reduced mean attack duration.

<p>Figure demonstrates the mean duration (time from the start of the attack to the complete resolution of symptoms) of attacks treated before and after each timepoint. n = 207 attacks (<1 hour, n = 80; ≥1 hour, n = 127; <2 hours, n = 120; ≥2 hours, n = 87; <5 hours, n = 145; ≥5 hours, n = 62); all attacks are included at each timepoint; ***<i>p</i><0.001.</p

Frequency of typical IgE patterns obtained by western blot inhibition in CAP double sensitized patients.

<p>CCD: cross-reactive carbohydrate determinants, True DS: true double sensitization, WB: western blot, WB-I (western blot inhibition): To discriminate between IgE specific for peptide or carbohydrate epitopes, antibody binding to CCDs was inhibited by preincubating sera with MUXF-BSA. Among these patients the majority of DS was CCD-dependent. DS due to protein components of hyaluronidases played a minor role. n = 61.</p