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Results: 1 to 10 of 31

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Risk-stratified Management to Remove Low-Risk Penicillin Allergy Labels in the ICU.
Stone CA, Stollings JL, Lindsell CJ, Dear ML, Buie RB, Rice TW, Phillips EJ
(2020) Am J Respir Crit Care Med 201: 1572-1575
MeSH Terms: Amoxicillin, Anti-Bacterial Agents, Diagnostic Errors, Drug Hypersensitivity, Humans, Intensive Care Units, Penicillins, Risk Assessment, Skin Tests
Added March 30, 2020
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9 MeSH Terms
Penicillin Allergy.
Castells M, Khan DA, Phillips EJ
(2019) N Engl J Med 381: 2338-2351
MeSH Terms: Adult, Anaphylaxis, Anti-Bacterial Agents, Child, Desensitization, Immunologic, Drug Hypersensitivity, Humans, Immunologic Tests, Penicillins, Skin Tests
Added March 30, 2020
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MeSH Terms
Cephalosporin Allergy: Current Understanding and Future Challenges.
Khan DA, Banerji A, Bernstein JA, Bilgicer B, Blumenthal K, Castells M, Ein D, Lang DM, Phillips E
(2019) J Allergy Clin Immunol Pract 7: 2105-2114
MeSH Terms: Anaphylaxis, Basophil Degranulation Test, Cephalosporins, Cross Reactions, Desensitization, Immunologic, Drug Eruptions, Drug Hypersensitivity, Humans, Perioperative Period, Pharmacogenomic Variants, Serum Sickness, Skin Tests, beta-Lactams
Show Abstract · Added March 30, 2020
Cephalosporins are commonly used antibiotics both in hospitalized patients and in outpatients. Hypersensitivity reactions to cephalosporins are becoming increasingly common with a wide range of immunopathologic mechanisms. Cephalosporins are one of the leading causes for perioperative anaphylaxis and severe cutaneous adverse reactions. Patients allergic to cephalosporins tend to tolerate cephalosporins with disparate R1 side chains but may react to other beta-lactams with common R1 side chains. Skin testing for cephalosporins has not been well validated but appears to have a good negative predictive value for cephalosporins with disparate R1 side chains. In vitro tests including basophil activation tests have lower sensitivity when compared with skin testing. Rapid drug desensitization procedures are safe and effective and have been used successfully for immediate and some nonimmediate cephalosporin reactions. Many gaps in knowledge still exist regarding cephalosporin hypersensitivity.
Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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13 MeSH Terms
Immune-mediated adverse reactions to vaccines.
Stone CA, Rukasin CRF, Beachkofsky TM, Phillips EJ
(2019) Br J Clin Pharmacol 85: 2694-2706
MeSH Terms: Guillain-Barre Syndrome, Humans, Hypersensitivity, Delayed, Hypersensitivity, Immediate, Immunocompromised Host, Immunoglobulin E, Skin Tests, T-Lymphocytes, Vaccination, Vaccine Excipients, Vaccines
Show Abstract · Added March 30, 2020
Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.
© 2019 The British Pharmacological Society.
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11 MeSH Terms
Beta-Lactam and Sulfonamide Allergy Testing Should Be a Standard of Care in Immunocompromised Hosts.
Trubiano JA, Slavin MA, Thursky KA, Grayson ML, Phillips EJ
(2019) J Allergy Clin Immunol Pract 7: 2151-2153
MeSH Terms: Anti-Bacterial Agents, Chemoprevention, Drug Hypersensitivity, Humans, Immunocompromised Host, Penicillins, Self Report, Skin Tests, Sulfonamides, Trimethoprim, Sulfamethoxazole Drug Combination, beta-Lactams
Show Abstract · Added March 30, 2020
Antibiotic allergies are reported in up to 1 in 4 immunocompromised hosts with significant impacts on antibiotic utilization and patient outcomes. Health services programs focused on de-labeling beta-lactam and sulfonamide allergy labels should be a standard of care in immunocompromised hosts.
Copyright © 2019 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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11 MeSH Terms
Controversies in drug allergy: Testing for delayed reactions.
Phillips EJ, Bigliardi P, Bircher AJ, Broyles A, Chang YS, Chung WH, Lehloenya R, Mockenhaupt M, Peter J, Pirmohamed M, Roujeau JC, Shear NH, Tanno LK, Trubiano J, Valluzzi R, Barbaud A
(2019) J Allergy Clin Immunol 143: 66-73
MeSH Terms: Animals, Asian Continental Ancestry Group, Carbamazepine, Dideoxynucleosides, HLA-B Antigens, HLA-B15 Antigen, Humans, Skin Tests, Stevens-Johnson Syndrome
Show Abstract · Added March 30, 2020
Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell-mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized.
Stone CA, Liu Y, Relling MV, Krantz MS, Pratt AL, Abreo A, Hemler JA, Phillips EJ
(2019) J Allergy Clin Immunol Pract 7: 1533-1540.e8
MeSH Terms: Allergens, Cross Reactions, Humans, Hypersensitivity, Immediate, Immunoglobulin E, Male, Middle Aged, Polyethylene Glycols, Polysorbates, Skin Tests
Show Abstract · Added March 30, 2020
BACKGROUND - The most common immediate hypersensitivity to macrogols is associated with polyethylene glycol (PEG) 3350; however, the epidemiology, mechanisms, and cross-reactivity are poorly understood. Thousands of medications contain either PEGs or structurally similar polysorbates.
OBJECTIVE - Our objective was to better understand the mechanism, cross-reactivity, and scope of PEG hypersensitivity.
METHODS - Two cases with a past history of immediate hypersensitivity to PEG-containing medications were used to study potential mechanisms and cross-reactivity of immediate reactions to PEG 3350. Skin testing and oral challenges with PEG and polysorbate-containing agents were employed to determine clinical reactivity and cross-reactivity between the 2 allergens. Enzyme-linked immunosorbent assay and electrochemiluminescent immunoassay were used to detect anti-PEG specific IgG and IgE, respectively, using PEGylated protein or PEG alone as antigens in 2 cases and 6 PEG 3350 tolerant controls. We searched US Food and Drug Administration (FDA) adverse event reports for immediate reactions to PEG 3350 to determine the potential scope of this problem in the United States.
RESULTS - Skin and provocation testing demonstrated symptomatic reactivity in both cases to PEG 3350 and polysorbate 80. Plasma samples were positive for anti-PEG specific IgE and IgG antibodies only in cases and binding increased directly proportional to the molecular weight of PEG tested. FDA adverse event reports revealed 53 additional cases of possible PEG 3350 anaphylaxis.
CONCLUSIONS - Immediate hypersensitivity to PEG 3350 with cross-reactive polysorbate 80 hypersensitivity may be underrecognized in clinical practice and can be detected with clinical skin testing. Our studies raise the possibility of an IgE-mediated type I hypersensitivity mechanism in some cases.
Copyright © 2018 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
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10 MeSH Terms
The safety of antibiotic skin testing in severe T-cell-mediated hypersensitivity of immunocompetent and immunocompromised hosts.
Trubiano JA, Douglas AP, Goh M, Slavin MA, Phillips EJ
(2019) J Allergy Clin Immunol Pract 7: 1341-1343.e1
MeSH Terms: Aged, Allergens, Anti-Bacterial Agents, Drug Hypersensitivity, Female, Humans, Hypersensitivity, Delayed, Immunocompetence, Immunocompromised Host, Male, Middle Aged, Practice Guidelines as Topic, Skin Tests, T-Lymphocytes
Added March 30, 2020
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14 MeSH Terms
Anaphylaxis after vaccination in a pediatric patient: further implicating alpha-gal allergy.
Stone CA, Commins SP, Choudhary S, Vethody C, Heavrin JL, Wingerter J, Hemler JA, Babe K, Phillips EJ, Norton AE
(2019) J Allergy Clin Immunol Pract 7: 322-324.e2
MeSH Terms: Allergens, Anaphylaxis, Angioedema, Animals, Cattle, Chickenpox Vaccine, Child, Preschool, Dyspnea, Food Hypersensitivity, Gelatin, Humans, Immunoglobulin E, Male, Mass Vaccination, Measles-Mumps-Rubella Vaccine, Skin Tests, Urticaria
Added March 30, 2020
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17 MeSH Terms
How antibiotic allergy labels may be harming our most vulnerable patients.
Trubiano JA, Grayson ML, Thursky KA, Phillips EJ, Slavin MA
(2018) Med J Aust 208: 469-470
MeSH Terms: Anti-Bacterial Agents, Drug Hypersensitivity, Drug Labeling, Drug Resistance, Microbial, Global Health, Humans, Penicillins, Risk Factors, Skin Tests, beta-Lactamases
Added March 30, 2020
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