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      Protocolo de desensibilización a levofloxacino en paciente con infección osteoarticular. A propósito de un caso Translated title: Desensitization protocol with levofloxacin in patient with osteoarticual infection. Report of clinical case

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          Abstract

          RESUMEN Las reacciones alérgicas y cutáneas para fluoroquinolonas las presentan entre el 0,4% y el 2,2% de los pacientes. Se presenta un protocolo de desensibilización por vía intravenosa que se desarrolla en 4 horas con dosis de 0,05 mg hasta una dosis acumulada de 750 mg.

          Translated abstract

          SUMMARY Allergic and cutaneous reactions to fluoroquinolones are shown among 0.4% and 2.2% of the patients. A protocol of intravenous desensitization is presented, which develops in 4 hours with a dose of 0.05 mg to a cumulative dose of 750 mg.

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          General considerations on rapid desensitization for drug hypersensitivity - a consensus statement.

          Drug hypersensitivity reactions can occur with most drugs, are unpredictable, may affect any organ or system, and range widely in clinical severity from mild pruritus to anaphylaxis. In most cases, the suspected drug is avoided in the future. However, for certain patients, the particular drug may be essential for optimal therapy. Under these circumstances, desensitization may be performed. Drug desensitization is defined as the induction of a temporary state of tolerance of a compound responsible for a hypersensitivity reaction. It is performed by administering increasing doses of the medication concerned over a short period of time (from several hours to a few days) until the total cumulative therapeutic dose is achieved and tolerated. It is a high-risk procedure used only in patients in whom alternatives are less effective or not available after a positive risk/benefit analysis. Desensitization protocols have been developed and are used in patients with allergic reactions to antibiotics (mainly penicillin), insulins, sulfonamides, chemotherapeutic and biologic agents, and many other drugs. Desensitization is mainly performed in IgE-mediated reactions, but also in reactions where drug-specific IgE have not been demonstrated. Desensitization induces a temporary tolerant state, which can only be maintained by continuous administration of the medication. Thus, for treatments like chemotherapy, which have an average interval of 4 weeks between cycles, the procedure must be repeated for every new course. In this paper, some background information on rapid desensitization procedures is provided. We define the drugs and drug reactions indicated for such procedures, describe the possible mechanism of action, and discuss the indications and contraindications. The data should serve as background information for a database (accessible via the EAACI-homepage) with standardized protocols for rapid desensitization for antibiotics, chemotherapeutic agents, monoclonal antibodies/fusion proteins, and other drugs. © 2010 John Wiley & Sons A/S.
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            Hypersensitivity reactions to chemotherapeutic drugs.

            There is an ever-increasing number of therapeutics used to treat cancer. A recent publication listed 86 currently available antineoplastic medications. Despite this large number, hypersensitivity reactions are not common except with platinum compounds (cisplatin, carboplatin), epipodophyllotoxins (teniposide, etoposide), asparaginase, taxanes (paclitaxel), and procarbazine. Doxorubicin and 6-mercaptopurine are occasionally associated with hypersensitivity reaction. Comparable reactions with other chemotherapeutic agents are. uncommon; many are only anecdotal reports. Reactions associated with individual drugs are discussed in detail. The mechanisms responsible for most of these reactions are not known, as they have generally not been evaluated. The term "hypersensitivity" is widely used in the chemotherapy literature without a common definition. Hypersensitivity is defined here as an unexpected reaction with signs and symptoms not consistent with known toxicity of the drug. Most reactions are coincident with or within hours of drug administration. Almost all are associated with parenteral administration. Symptoms include flushing, alterations in heart rate and blood pressure, dyspnea and bronchospasm, back pain, fever, pruritus, nausea and all types of rashes. Some cases may be due to non-immune mediated release of histamine or cytokines, as many patients can subsequently tolerate re-exposure after pretreatment with steroids and antihistamine, and slow readministration of the drug. This is more compatible with a graded challenge, than desensitization and is generally successful for taxanes, less so for platinum compounds. In most cases hypersensitivity reactions are associated with the specific chemotherapeutic drug. Reaction rates may vary with different forms of the drugs, e.g. pegylated. Occasionally excipients such as Cremaphor EL may induce hypersensitivity reactions.
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              Tratado de Alergología

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                Author and article information

                Journal
                ofil
                Revista de la OFIL
                Rev. OFIL·ILAPHAR
                Organización de Farmacéuticos Ibero-Latinoamericanos (Madrid, Madrid, Spain )
                1131-9429
                1699-714X
                2020
                : 30
                : 1
                : 65-66
                Affiliations
                [1] Huelva orgnameHospital Juan Ramón Jiménez orgdiv1Servicio de Farmacia España
                [3] orgnameHospital Juan Ramón Jiménez-Hospital Infanta Elena orgdiv1UGC intercentros de Enfermedades Infecciosas España
                [2] Huelva orgnameHospital Juan Ramón Jiménez orgdiv1Servicio de Farmacia España
                Article
                S1699-714X2020000100016 S1699-714X(20)03000100016
                3172d87b-6048-418e-89be-f5021d5bb8ef

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 06 December 2018
                : 12 January 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 2
                Product

                SciELO Spain

                Categories
                Casos Clínicos

                bone,Levofloxacino,hueso,Levofloxacin,desensibilización inmunológica,immunologic desensitization

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