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Acute erythematous rash on the trunk and limbs
Published in Richard Ashton, Barbara Leppard, Differential Diagnosis in Dermatology, 2021
Richard Ashton, Barbara Leppard
Acute urticaria may be caused by: A type 1 allergic response, which occurs within a few minutes of contact with an allergen either on the skin (e.g. nettle rash, latex allergy see p. 299) or ingested (e.g. strawberries or penicillin). The rash disappears spontaneously within an hour. Contact with the same allergen again will result in a further episode.Direct release of histamine from mast cells by aspirin, codeine or opiates. IgE is not involved. This is the commonest cause of infrequent acute episodes of urticaria, occurring when a patient takes aspirin for a cold or headache.Drugs which can cause serum sickness (an immune complex reaction). Urticaria, arthralgia, fever and lymphadenopathy are the hall marks of this. It may be caused by the following drugs:PenicillinPhenothiazinesThiazide diureticsNitrofurantoinThiouracil
Overview of Cell Adhesion Molecules and Their Antagonism
Published in Bruce S. Bochner, Adhesion Molecules in Allergic Disease, 2020
Eight patients received a second course of the murine anti-ICAM-1 mAb (55). Of note, six patients developed serum sickness-like symptoms several days after the second course of treatment. Although the precise underlying mechanisms have not been defined, these symptoms are presumed to relate to the formation of immune complexes, possibly consisting of HAMA/anti-ICAM-1 mAb/circulating ICAM-1. In support of this, all patients developed detectable HAMA after the first treatment. In addition, there was evidence of transient depletion of complement proteins during the second course of therapy that was not observed in the initial course. Moreover, the clinical benefit associated with the second course of therapy was far inferior to that of the first course, both in the number of patients responding as well as the duration of response. In summary, these observations indicate that although ICAM-1 appears to be an appropriate target for antiadhesion therapy in RA, a murine mAb is not a suitable agent on account of its immunogenicity.
Therapeutic Uses and Side Effects
Published in Fazal-I-Akbar Danish, Ahmed Ehsan Rabbani, Pharmacology in 7 Days for Medical Students, 2018
Fazal-I-Akbar Danish, Ahmed Ehsan Rabbani
Allergic reactions include: Urticaria, severe pruritus and joint swelling.Skin rashes of various types.Serum sickness-like syndrome.Allergic renal disturbances (interstitial nephritis).Allergic blood dyscrasias (hemolytic anaemia).Acute anaphylactic shock.
Incidence of serum sickness following Indian polyvalent antivenom therapy in a cohort of snake-envenomed patients in rural Sri Lanka
Published in Clinical Toxicology, 2023
Subodha Waiddyanatha, Anjana Silva, Supun Wedasingha, Sisira Siribaddana, Geoffrey K. Isbister
The definition and diagnostic criteria for serum sickness have not been validated to date, which is the most likely reason for the vast difference in the rates of serum sickness reported between studies − 4% to 56% [8,14]. Serum sickness is defined as an immune-complex-mediated hypersensitivity reaction that classically presents with fever, rash, polyarthritis, or polyarthralgia [22]. Most studies have used a combination of these clinical features as part of their definition, including the present study here and an Australian study [14]. Ruha et al. [29] reported 7% of patients having serum sickness, based on rash, pruritis, fever, myalgia, and arthralgia for the diagnosis. Lavonas et al. [30] used the same criteria, but included the presence of vomiting, and reported 4.9% having serum sickness. Bush et al. [31] used fever, arthralgia, and pruritus as diagnostic criteria for serum sickness, and reported 6.7% of patients developing serum sickness, after Crotalidae polyvalent immune Fab (ovine) antivenom for Southern Pacific rattlesnake (Crotalus helleri) envenomation. LoVecchio et al. [15] reported the highest rate of serum sickness in 56% of cases following the administration of crotalid Wyeth polyvalent antivenom (equine, whole IgG), for rattlesnake envenomation. However, LoVecchio et al. defined serum sickness as the development of an unexplained rash within 3 to 21 days of antivenom administration, likely increasing the number of patients meeting the definition of serum sickness [15].
The democratization of de-labeling: a review of direct oral challenge in adults with low-risk penicillin allergy
Published in Expert Review of Anti-infective Therapy, 2020
Morgan Thomas Rose, Monica Slavin, Jason Trubiano
In a prospective case series over 12 months, Li et al. identified 70 adult inpatients with low-risk penicillin AALs at an Australian center with an infective diagnosis requiring beta-lactam therapy. Low-risk allergy phenotypes were defined as (I)Type A ADRs, and (II) all immune-mediated reactions excluding – (i) anaphylaxis (within 10 years), (ii) hemolytic anemia, (iii) serum sickness, and (iv) severe cutaneous adverse reactions (SCAR). Sixty-three proceeded to 3-stage graded oral challenge with amoxicillin (2.5 mg/25 mg/250 mg-30 min interval, 2 h total observation post-last dose) and completed a 3-day course of the target dose. Of these, 56 had described a suspected immune-mediated allergy history. Fifty-four of 56 completed the challenge without complication, 2 (3.6%) described delayed rash without systemic symptoms after 3 and 4 days of beta-lactam therapy, respectively. In comparison to historical controls, statistically significant reductions were seen in the length of stay, cost of antimicrobials, and overall admission costs, in addition to a reduction in the rate of readmission [48].
Hypersensitivity and adverse reactions to biologics for asthma and allergic diseases
Published in Expert Review of Clinical Immunology, 2020
Dupilumab can be self-administered at home after proper training and is generally well tolerated. In a phase 3 trial on a group of 1902 asthma patients 12 years of age and older for 52 weeks, dupilumab has demonstrated a good safety profile [41]. The reported adverse events were benign. Common reactions reported compared to placebo were injection site reaction (14–18% vs 6%), oropharyngeal pain (2% vs 1%), and eosinophilia (4.1% vs 0.6%). In another study, eosinophilia was noted in up to 14% vs. 1% for placebo [43]. Transient eosinophilia may reach ≥3, 000 cells/μL and is thought to be the result of inhibition of migration from the circulation to the tissues [40,41]. Consequences of such hypereosinophilia were rare; eosinophilic pneumonia in two patients and vasculitis consistent with eosinophilic granulomatosis with polyangiitis in two other. The predisposing factor that led to these two complications was unknown. Currently, there is no available guidelines on monitoring eosinophilia in patients on dupilumab. Excretion of this drug by the lacrimal glands often leads to conjunctivitis in 2–28% of patients. Other ocular complications occurred in 1–10% of patients in the form of blepharitis, eye pruritus, keratitis, and dry eye. Oro-facial herpes simplex infection was also reported in 1–10% of patients. Hypersensitivity reactions, mainly generalized urticaria, occurred in 0.1–1%. Very rarely, serum sickness (<0.01%) developed.