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      Hypersensitivity reactions to non beta-lactam antimicrobial agents, a statement of the WAO special committee on drug allergy

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          Abstract

          Antibiotics are used extensively in the treatment of various infections. Consequently, they can be considered among the most important agents involved in adverse reactions to drugs, including both allergic and non-allergic drug hypersensitivity [J Allergy Clin Immunol 113:832–836, 2004]. Most studies published to date deal mainly with reactions to the beta-lactam group, and information on hypersensitivity to each of the other antimicrobial agents is scarce. The present document has been produced by the Special Committee on Drug Allergy of the World Allergy Organization to present the most relevant information on the incidence, clinical manifestations, diagnosis, possible mechanisms, and management of hypersensitivity reactions to non beta-lactam antimicrobials for use by practitioners worldwide.

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          American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis.

          Henry M. Blumberg, William Burman, Richard Chaisson … (2003)
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            The lymphocyte transformation test in the diagnosis of drug hypersensitivity.

            W Pichler, J Tilch (2004)
            Diagnosis of drug hypersensitivity is difficult, as an enormous amount of different drugs can elicit various immune-mediated diseases with distinct pathomechanism. The lymphocyte transformation test (LTT) measures the proliferation of T cells to a drug in vitro--from which one concludes to a previous in vivo reaction due to a sensitization. This concept of the LTT has been confirmed by the generation of drug-specific T-cell clones and the finding that drugs can directly interact with the T-cell receptor, without previous metabolism or need to bind to proteins. In this review, technical aspects and usefulness of this test for the diagnosis of drug hypersensitivity are discussed. The main advantage of this test is its applicability with many different drugs in different immune reactions, as drug-specific T cell are almost always involved in drug hypersensitivity reactions. Its main disadvantages are that an in vitro proliferation of T cells to a drug is difficult to transfer to the clinical situation and that the test per se is rather cumbersome and technically demanding. In addition, its sensitivity is limited (for beta-lactam allergy it is in the range of 60-70%), - although at least in our hands - it is higher than of other tests for drug hypersensitivity diagnosis. Consequently, drug hypersensitivity diagnosis needs to rely on a combination of history and different tests, as none of the single tests available has per se a sufficiently good sensitivity. Within this setting, the LTT has proven to be a useful test for the diagnosis of drug hypersensitivity reactions and helped to better understand these reactions. Further work on the simplification of this test and systematic evaluation of its sensitivity and specificity in some main groups of drugs are necessary to make this test more widely available.
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              Association of chronic nasal carriage of Staphylococcus aureus and higher relapse rates in Wegener granulomatosis.

              W Sluiter, Coen Stegeman, E Haan … (1994)
              To examine possible risk factors for relapse, including chronic nasal carriage of Staphylococcus aureus and serial antineutrophil cytoplasmic antibody (ANCA) determinations in patients with Wegener granulomatosis. Observational cohort study. Outpatient clinic at a university-affiliated hospital. Consecutive patients (n = 71) with biopsy-proven Wegener granulomatosis who were seen during follow-up at the outpatient clinic from January 1988 to July 1991. Fourteen patients were ineligible or dropped out; 57 patients were analyzed. Serial ANCA determinations and swab cultures of both anterior nares for S. aureus taken at each visit every 4 to 6 weeks. Occurrence of infections and relapses of Wegener granulomatosis were identified according to strict, predefined criteria. Thirty-six of the 57 patients (63%; 95% CI, 49% to 76%) were found to be chronic nasal carriers of S. aureus (> or = 75% of nasal cultures positive for S. aureus). Proportional-hazards regression analysis identified chronic nasal carriage of S. aureus (adjusted relative risk, 7.16; CI, 1.63 to 31.50), creatinine clearance above 60 mL.min-1 (adjusted relative risk, 2.94; CI, 1.27 to 6.67), and a history of previous relapses of Wegener granulomatosis (adjusted relative risk, 1.33; CI, 0.98 to 1.78) as independent risk factors for relapse. Twenty-two of 33 patients persistently or intermittently positive for ANCA had a relapse as opposed to only 1 of 21 persistently negative patients. Relapses of Wegener granulomatosis were not related to diagnosed infections. Chronic nasal carriage of S. aureus identifies a subgroup of patients with Wegener granulomatosis who are more prone to relapses of the disease, suggesting a role for S. aureus in its pathophysiology and a possible clue for treatment.
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                Author and article information

                Contributors
                Mario Sánchez-Borges: sanchezbmario@gmail.com
                Bernard Thong: bernard_thong@ttsh.com.sg
                Miguel Blanca: mblancago@gmail.com
                Luis Felipe Chiaverini Ensina: 100alergia@gmail.com
                Sandra González-Díaz: gonzalezdiazsandra@gmail.com
                Paul A Greenberger: p-greenberger@northwestern.edu
                Edgardo Jares: edgardo.jares@gmail.com
                Young-Koo Jee: ykjee@dku.edu
                Luciana Kase-Tanno: luciana.tanno@gmail.com
                David Khan: Dave.Khan@UTSouthwestern.edu
                Jung-Won Park: parkjw@yuhs.ac
                Werner Pichler: Werner.Pichler@insel.ch
                Antonino Romano: antoninoromano@h-columbus.it
                Maria José Torres Jaén: mjtorresj@gmail.com
                Journal
                Journal ID (nlm-ta): World Allergy Organ J
                Journal ID (iso-abbrev): World Allergy Organ J
                Title: The World Allergy Organization Journal
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1939-4551
                Publication date (Electronic): 31 October 2013
                Publication date PMC-release: 31 October 2013
                Publication date Collection: 2013
                Volume: 6
                Issue: 1
                Electronic Location Identifier: 18
                Affiliations
                [ ]Allergy and Clinical Immunology Department, Centro Médico-Docente La Trinidad, Caracas, Venezuela
                [ ]Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
                [ ]Allergy Service, Carlos Haya Hospital, Malaga, Spain
                [ ]Department of Genetics and Environmental Risks, Faculty of Medicine, University of Lorraine, Lorraine, France
                [ ]Allergy, Clinical Immunology and Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
                [ ]Servicio de Alergia e Inmunología Clínica, Hospital Universitario, Monterrey, Nuevo Leon Mexico
                [ ]Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
                [ ]Immunology and Allergy Unit, Hospital Nacional Alejandro Posadas, Buenos Aires, Provincia de Buenos Aires Argentina
                [ ]Department of Internal Medicine, Division of Allergy and Respiratory Medicine, Dankook University College of Medicine, Cheonan, South Korea
                [ ]Department of Internal Medicine, Hospital das Clínicas, Clinical Immunology and Allergy Service, University of São Paulo, São Paulo, Brazil
                [ ]Department of Allergy and Immunology, Hospital Servidor Público Estadual de São Paulo, São Paulo, Brazil
                [ ]Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, TX USA
                [ ]Department of Internal Medicine, Division of Allergy and Immunology, Yonsei University College of Medicine, Seoul, South Korea
                [ ]Clinic for Rheumatology and Clinical Immunology/Allergology, Inselspital, Bern, CH 3010 Switzerland
                [ ]Allergy Unit, Complesso Integrato Columbus, Rome, and IRCCS Oasi Maria SS, Troina, Italy
                Article
                Publisher ID: 84
                DOI: 10.1186/1939-4551-6-18
                PMC ID: 4446643
                PubMed ID: 24175948
                SO-VID: d42ff476-92ef-4d38-aec5-27b621dcc5b6
                Copyright © © Sánchez-Borges et al.; licensee BioMed Central Ltd. 2013
                License:

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 10 September 2013
                Date accepted : 18 September 2013
                Categories
                Subject: Review
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                issue-copyright-statement © The Author(s) 2013

                ScienceOpen disciplines: Immunology
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                ScienceOpen disciplines: Immunology

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