Φαρμακευτική αλλεργία: Πρόσφατες τοποθετήσεις της ομάδας φαρμακευτικής αλλεργίας της Ευρωπαϊκής Ακαδημίας Αλλεργιολογίας, Άσθματος και Κλινικής Ανοσολογίας (EAACI)_Ιούνιος-Ιούλιος 2013.

Πρόσφατα (Ιούνιος και Ιούλιος 2013), δημοσιεύθηκαν στο περιοδικό Allergy, δύο τοποθετήσεις της ομάδας φαρμακευτικής αλλεργίας της EAACI.

Η πρώτη – «Skin test concentrations for systemically administered drugs» -περιλαμβάνει δεδομένα για τις μη ερεθιστικές συγκεντρώσεις των β-λακταμικών αντιβιοτικών, γενικών αναισθητικών και ορισμένων επιπλέον φαρμακευτικών ουσιών (αντιπηκτικά, χημειοθεραπευτικά φάρμακα, μη στερινοειδή αντιφλεγμονώδη φάρμακα, αντιεπιληπτικά, σκιαγραφικά, μονοκλωνικά αντισώματα, αναστολείς της ατλίας πρωτονίων, εμβόλια, αντιυπερτασικά). Σημαντική η συζήτηση για τους περιορισμούς στην αξιολόγηση της αρνητικής προγνωστικής αξίας των δερματικών δοκιμασιών στην διερεύνηση της φαρμακευτικής αλλεργίας.

Η δεύτερη – «Desensitization in delayed drug hypersensitivity reactions» – διερευνά την σχετικά αμφιλεγόμενη δυνατότητα απευαισθητοποίησης σε ασθενείς με επιβραδυνόμενου τύπου φαρμακευτική αλλεργία (φαρμακευτικό εξάνθημα).

 

Brockow K, Garvey LH, Aberer W, Atanaskovic-Markovic M, Barbaud A, Bilo MB, Bircher A, Blanca M, Bonadonna B, Campi P, Castro E, Cernadas JR, Chiriac AM, Demoly P, Grosber M, Gooi J, Lombardo C, Mertes PM, Mosbech H, Nasser S, Pagani M, Ring J, Romano A, Scherer K, Schnyder B, Testi S, Torres M, Trautmann A, Terreehorst I; ENDA/EAACI Drug Allergy Interest Group.

Skin test concentrations for systemically administered drugs — an ENDA/EAACI Drug Allergy Interest Group position paper.

Allergy. 2013 Jun;68(6):702-12.

Abstract

Skin tests are of paramount importance for the evaluation of drug hypersensitivity reactions. Drug skin tests are often not carried out because of lack of concise information on specific test concentrations. The diagnosis of drug allergy is often based on history alone, which is an unreliable indicator of true hypersensitivity.To promote and standardize reproducible skin testing with safe and nonirritant drug concentrations in the clinical practice, the European Network and European Academy of Allergy and Clinical Immunology (EAACI) Interest Group on Drug Allergy has performed a literature search on skin test drug concentration in MEDLINE and EMBASE, reviewed and evaluated the literature in five languages using the GRADE system for quality of evidence and strength of recommendation. Where the literature is poor, we have taken into consideration the collective experience of the group.We recommend drug concentration for skin testing aiming to achieve a specificity of at least 95%. It has been possible to recommend specific drug concentration for betalactam antibiotics, perioperative drugs, heparins, platinum salts and radiocontrast media. For many other drugs, there is insufficient evidence to recommend appropriate drug concentration. There is urgent need for multicentre studies designed to establish and validate drug skin test concentration using standard protocols. For most drugs, sensitivity of skin testing is higher in immediate hypersensitivity compared to nonimmediate hypersensitivity.

 

Η πρόσβαση στο πλήρες κείμενο της οδηγίας είναι ελεύθερη από την ιστοσελίδα του εκδότη:

http://onlinelibrary.wiley.com/doi/10.1111/all.12142/full

 

Scherer K, Brockow K, Aberer W, Gooi JH, Demoly P, Romano A, Schnyder B, Whitaker P, Cernadas JS, Bircher AJ; for ENDA, the European Network on Drug Allergy and the EAACI Drug Allergy Interest Group.

Desensitization in delayed drug hypersensitivity reactions – an EAACI position paper of the Drug Allergy Interest Group.

Allergy. 2013 Jul;68(7):844-52.

Abstract

Drug hypersensitivity may deprive patients of drug therapy, and occasionally no effective alternative treatment is available. Successful desensitization has been well documented in delayed drug hypersensitivity reactions. In certain situations, such as sulfonamide hypersensitivity in HIV-positive patients or hypersensitivity to antibiotics in patients with cystic fibrosis, published success rates reach 80%, and this procedure appears helpful for the patient management. A state of clinical tolerance may be achieved by the administration of increasing doses of the previously offending drug. However, in most cases, a pre-existent sensitization has not been proven by positive skin tests. Successful re-administration may have occurred in nonsensitized patients. A better understanding of the underlying mechanisms of desensitization is needed. Currently, desensitization in delayed hypersensitivity reactions is restricted to mild, uncomplicated exanthems and fixed drug eruptions. The published success rates vary depending on clinical manifestations, drugs, and applied protocols. Slower protocols tend to be more effective than rush protocols; however, underreporting of unsuccessful procedures is very probable. The decision to desensitize a patient must always be made on an individual basis, balancing risks and benefits. This paper reviews the literature and presents the expert experience of the Drug Hypersensitivity Interest Group of the European Academy of Allergy and Clinical Immunology.

Η πρόσβαση στο πλήρες κείμενο της οδηγίας είναι ελεύθερη από την ιστοσελίδα του εκδότη:

http://onlinelibrary.wiley.com/doi/10.1111/all.12161/full