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Recent insights on functional heartburn and reflux hypersensitivity.

PURPOSE OF REVIEW: Rome IV experts have proposed that gastroesophageal reflux disease (GERD) should be diagnosed only in patients with abnormal esophageal acid exposure, and that reflux hypersensitivity (RH) and functional heartburn (FH) both should be considered functional conditions separate from GERD. Although past and recent evidence support that FH can be completely distinguished from GERD, the concept that RH is not GERD is highly questionable. This review attempts to provide current data on these issues. RECENT FINDINGS: Many recent investigations have provided new data on the differen…

Hyperosmia after COVID-19: hedonic perception or hypersensitivity?

Magnetic resonance (MR) is used more and more frequently to diagnose changes in the musculoskeletal system in the course of rheumatic diseases, at their initial assessment, for treatment monitoring and for identification of complications. The article presents the history of magnetic resonance imaging, the basic principles underlying its operation as well as types of magnets, coils and MRI protocols used in the diagnostic process of rheumatic diseases. It enumerates advantages and disadvantages of individual MRI scanners. The principles of MRI coil operation are explained, and the sequences use

Hypersensitivity reactions to biologicals: An EAACI position paper.

Biologicals are crucial targeted therapeutic agents in oncological, immunological, and inflammatory diseases, and their use in clinical practice is broadening. In recent years, the spread of Personalized Precision Medicine has facilitated a proliferation of new treatment options, especially biologicals. Consequently, biologicals are now among the drugs that most frequently cause hypersensitivity reactions (HSRs). Patients can develop HSRs to these agents during the first-lifetime exposure or after repeated exposure, and these HSRs can be potentially life-threatening or limit therapeutic option…

Hypersensitivity reactions to chemotherapy: an EAACI Position Paper.

Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most react…

Vancomycin Hypersensitivity Reactions Documented in Electronic Health Records.

BACKGROUND: Vancomycin, the most common antimicrobial used in US hospitals, can cause diverse adverse reactions, including hypersensitivity reactions (HSRs). Yet, little is known about vancomycin reactions documented in electronic health records. OBJECTIVE: To describe vancomycin HSR epidemiology from electronic health record allergy data. METHODS: This was a cross-sectional study of patients with 1 or more encounter from 2017 to 2019 and an electronic health record vancomycin drug allergy label (DAL) in 2 US health care systems. We determined prevalence and trends of vancomycin DALs and ass…

Cutaneous Cell-Mediated Delayed Hypersensitivity to Intravitreal Bevacizumab.

The literature contains few reports describing autoimmune reactions to intravitreal bevacizumab and no Type-IV delayed hypersensitivity reactions. This was unexpected, as administration of intravenous bevacizumab has frequently caused dermatologic side-effects. This difference was likely attributable in part to the minimum 300-times difference between intravitreal versus intravenous dosing. Here, we present a case of a 52-year-old male who was treated with plaque brachytherapy for a subfoveal choroidal melanoma. The patient was treated with intravitreal bevacizumab for macular edema, retinal d…

Hypersensitivity Myocarditis Due to Antitubercular Drugs in Children.

BACKGROUND: Drug-related hypersensitivity myocarditis is a rare acute hypersensitivity reaction to therapeutic agents. Reports of antitubercular drugs causing hypersensitivity myocarditis are not described in literature. METHODS: Retrospective chart review of children admitted between January 1, 2016, and March 31, 2019, was conducted to identify children receiving antitubercular drugs who were diagnosed with hypersensitivity myocarditis. RESULTS: Three children (2 girls), who had hypersensitivity myocarditis due to antitubercular therapy, were identified. Cases 1 and 2 developed hypersensit…

Esophageal reflux hypersensitivity: Non-GERD or still GERD?

The most recent iteration of the classifications for functional esophageal disorders, Rome IV, proposed relevant modifications of the previous definitions for Rome III. They specifically considered increased esophageal acid exposure as the marker of gastroesophageal reflux disease (GERD), including the remaining part of non-erosive reflux disease patients with normal acid in the group with functional alterations, considering both reflux hypersensitivity and functional heartburn. However, recent pathophysiological and therapeutic data suggest the need for a return to including reflux hypersensi…

Serum specific IgE antibodies in immediate drug hypersensitivity.

Immediate drug hypersensitivity reactions (IDHRs) constitute a significant health problem that may be compounded by consequences of diagnostic error. In daily practice, IDHR diagnostic work up starts with drug-specific skin testing and/or quantification of specific IgE (sigE) antibodies in serum. Here we critically review the performance, i.e. potential and limitations of sIgE to β-lactam antibiotics (β-LABs), curarizing neuromuscular blocking agents (NMBAs), opiates and (semi)synthetic opioids, fluoroquinolones (FQs), poppy seed (papaver somniferum), chlorhexidine and finally Hevea latex. Qui…

Transbronchial Cryobiopsy for Miliary Tuberculosis Mimicking Hypersensitivity Pneumonitis.

Miliary tuberculosis is a potentially lethal type of tuberculosis that results from the hematogenous dissemination of Mycobacterium tuberculosis bacilli. We herein describe the case of a 34-year-old man that presented with a one-month history of cough and fever, while his sputum smear results were negative. Chest computed tomography revealed bilateral centrilobular ground-glass opacification (GGO), suggestive of hypersensitivity pneumonitis; thus, bronchoscopy was performed. Cryobiopsy specimens revealed necrotic granulomas. A re-examination of sputum after bronchoscopy identified Mycobacteriu…

Electromagnetic hypersensitivity (EHS, microwave syndrome) - Review of mechanisms.

Electromagnetic hypersensitivity (EHS), known in the past as "Microwave syndrome", is a clinical syndrome characterized by the presence of a wide spectrum of non-specific multiple organ symptoms, typically including central nervous system symptoms, that occur following the patient's acute or chronic exposure to electromagnetic fields in the environment or in occupational settings. Numerous studies have shown biological effects at the cellular level of electromagnetic fields (EMF) at magnetic (ELF) and radio-frequency (RF) frequencies in extremely low intensities. Many of the mechanisms describ…

Imiquimod enhances DNFB mediated contact hypersensitivity in mice.

Imiquimod (Imiq) is a synthetic imizoquinoline compound which can act on Toll-like receptor (TLR)7 and transduce signals involved in cell activation. We investigated the role of Imiq on contact hypersensitivity (CHS) and explored the potential mechanisms of mast cells involved in the process. Topical application of Imiq cream augmented DNFB mediated CHS in C57BL/6 mice. Imiq application induced skin inflammation and increased the number of dendritic cells (DCs) in the draining lymph nodes (DLNs). The splenic cell proliferation to DNBS in DNFB and Imiq treated mice was greater than that in mice…

Phenobarbital-induced anticonvulsant hypersensitivity syndrome in a cat.

In this study, we document a case of phenobarbital-induced anticonvulsant hypersensitivity syndrome (AHS), which has been rarely reported in veterinary medicine. A 2-year-old, 5.4 kg, neutered male Russian Blue cat was diagnosed with idiopathic epilepsy and started on phenobarbital treatment. Eight days after initiation of phenobarbital treatment, the cat showed tachypnea and hyperthermia. CBC and serum biochemistry were unremarkable. However, the patient showed high serum amyloid A (SAA). On abdominal ultrasonography, generalized enlargement of abdominal lymph nodes and splenic multiple hypo-…

Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways.

More than 250 drugs carry a small but important dose-independent risk of initiating a delayed-type hypersensitivity reaction that leads to acute tubulointerstitial nephritis (TIN). Clinical manifestations are often non-specific, making epidemiological studies challenging. In severe cases, if cessation of the offending drug is not followed by a prompt improvement in renal function, corticosteroid therapy appears to enhance renal recovery rates. Other drugs, classified as potential nephrotoxins, may induce dose-dependent acute tubular necrosis. Studies over the past decade have identified a uniq…

Drug Hypersensitivity due to Azathioprine with Elevated Procalcitonin.

We present a case of azathioprine hypersensitivity presenting as sepsis with elevated procalcitonin in a 68-year-old man with myasthenia gravis. The patient presented with fever, chills, nausea, vomiting, and headache. He developed numerous 1 cm erythematous papules over his upper torso. Infectious workup including bacteriological tests and microbial cultures was negative and a skin biopsy was performed which revealed suppurative folliculitis with eosinophils, consistent with drug hypersensitivity. Notably, acute phase reactants including C-reactive protein and procalcitonin were elevated upon…

Abstracts from the 8th Drug Hypersensitivity Meeting (DHM)

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… Thursday 19 April 2018 Beyond T cell in drug hypersensitivity O02 Oxidative stress and sulfonylarylamines hypersensitivity reactions: new insights Abdelbaset A. Elzagallaai, Michael J. Rieder Western University, London, Canada Correspondence: Abdelbaset A. … Conclusion Data from this study clearly indicate a major role of oxidative stress in the pathophysiology of SAAs hypersensitivity reactions. …

[Hypersensitivity pneumonitis and idiopathic pulmonary fibrosis - case report].

Hypersensitivity pneumonitis (HP), called extrinsic allergic alveolitis, is a syndrome characterized by diffuse inflammation of lung parenchyma and airways in response to the inhalation of antigens to witch the patient has been previously sensitized. The clinical presentation of HP have been categorized as acute, subacute and chronic. The patient with chronic HP may lack a history of acute episodes and usually reports the insidious onset of cough, dyspnoea, fatigue, and weight los. Idiopathic pulmonary fibrosis (IPF) is a type of lung disease that results in scarring (fibrosis) of the lungs fo…

Controversies in Drug Allergy: Beta-Lactam Hypersensitivity Testing.

All beta-lactam use is associated with a certain rate of adverse reactions. Many of these adverse reactions result in an allergy to the beta-lactam being entered into the patient's medical record. Unfortunately, only a small minority of these recorded allergies are clinically significant immunologically mediated drug hypersensitivity. An unconfirmed allergy to beta-lactams is a significant public health risk, because patients so labeled typically do not receive narrow-spectrum penicillins and cephalosporins when clinically indicated. The alternative antibiotics they receive result in poorer cl…

Acute hypersensitivity reaction to femoral drug-coated balloons.

We describe a case of an acute hypersensitivity reaction to a paclitaxel-coated balloon used in the peripheral arterial circulation. Clinicians using these products should be aware of this potential risk.