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Allergic Reactions: Anaphylaxis01:30

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Anaphylaxis is a severe, life-threatening hypersensitivity reaction mediated by Immunoglobulin E (IgE) antibodies. When IgE binds to allergens, it triggers the release of mediators– histamine, leukotrienes, and prostaglandins from mast cells and basophils. These mediators cause vasodilation, edema, and inflammation, leading to various symptoms.The primary allergens causing anaphylaxis include food items (e.g., peanuts, shellfish), drugs (e.g., penicillin, asparaginase, corticotropin,...
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Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial...
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Hypersensitivity, also known as a hypersensitivity reaction or allergic reaction, is a condition where the body's immune system reacts abnormally to a foreign substance. Such substances, that cause hypersensitivity are referred to as an allergen, could be something typically harmless to most people, like pollen or certain foods.
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Delayed-Type Hypersensitivity (DTH), or Type IV hypersensitivity, is a cell-mediated immune response. It occurs when T cells, rather than antibodies, mediate a reaction to specific antigens. It is characterized by a delayed onset (1-2 days) and involves the recruitment of macrophages to the inflammation site.The initiation of a DTH response begins with the sensitization of T cells. During this phase, which lasts at least 1-2 weeks, antigen-specific T cells are activated, clonally expanded, and...
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Allergic reactions related to drugs are hypersensitivity responses driven by the immune system and bear no connection to the drug's therapeutic action. While drugs in isolation do not trigger an immune response, they can interact with endogenous proteins to form antigens. These antigens stimulate lymphocytes to produce antibodies. IgE-type antibodies attach themselves to mast cells. Upon subsequent exposure to the same stimulus, the antigen-antibody interaction is initiated, unleashing...
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Oral Challenge without Skin Testing Safely Excludes Clinically Significant Delayed-Onset Penicillin Hypersensitivity.

Ronit Confino-Cohen1, Yossi Rosman1, Keren Meir-Shafrir2

  • 1Allergy and Clinical Immunology Unit, Meir General Hospital, Kfar-Saba, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

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PubMed
Summary

A 5-day oral penicillin challenge is a safe and effective way to rule out penicillin allergy in patients with nonimmediate reactions (NIR), eliminating the need for skin tests (ST). This approach ensures patient safety and simplifies allergy assessment.

Keywords:
Beta-lactamsDrug hypersensitivityNonimmediate penicillin allergyOral challenge

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Area of Science:

  • Clinical immunology
  • Pharmacology
  • Allergy and immunology

Background:

  • Penicillins are frequently implicated in hypersensitivity reactions.
  • Current guidelines suggest penicillin skin tests (ST) before re-administration for nonimmediate reactions (NIR).

Purpose of the Study:

  • To evaluate the necessity of ST prior to penicillin re-administration in patients with a history of NIR.
  • To determine if an oral challenge alone is sufficient for penicillin allergy assessment.

Main Methods:

  • Patients with NIR underwent penicillin ST, but results were disregarded for subsequent oral challenges.
  • A graded oral penicillin challenge (1/10th dose to full dose over 5 days) was administered.
  • Patients continued a 5-day course of the full therapeutic dose at home.

Main Results:

  • Out of 642 patients with alleged penicillin allergy, 96.1% completed an oral challenge.
  • Immediate reactions occurred in 1.5% of patients, irrespective of ST results (P = .7).
  • Late reactions and mild reactions during home challenge were observed in 4% and 6.1% of patients, respectively, regardless of ST outcomes.

Conclusions:

  • A 5-day oral penicillin challenge is a safe and sufficient method to exclude penicillin allergy after NIR.
  • Preceding skin tests are not necessary for penicillin allergy assessment in patients with NIR.