Journal articles on the topic 'Type IV hypersensitivity reactions'
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1
Maker, Jenana H., Cassandra M. Stroup, Vanthida Huang, and Stephanie F. James. "Antibiotic Hypersensitivity Mechanisms." Pharmacy 7, no. 3 (August 27, 2019): 122. http://dx.doi.org/10.3390/pharmacy7030122.
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Antibiotics are commonly prescribed to treat a variety of bacterial infections. As with all medications, hypersensitivity reactions may occur and clinicians should be able to recognize them accurately and recommend appropriate management. Antibiotic related hypersensitivity reactions may be one of four different types: Type I reactions, which are IgE mediated and may lead to anaphylaxis; Type II reactions that are antibody-mediated and may result in thrombocytopenia, neutropenia, or hemolytic anemia; Type III reaction that involves an immune complex formation such as vasculitis; and Type IV reactions that consist of four subtypes and typically include a rash of varying level of severity with or without systemic signs and symptoms. Herein, we describe the mechanisms of different types of allergic reactions to commonly prescribed antibiotics and offer recommendations for management. Further, we briefly refer to antibiotic reactions that mimic hypersensitivity reactions but are not immune mediated, such as pseudoallergies and serum sickness-like reactions.
2
Espínola, Silvio. "Type IV hypersensitivity to timolol." International Journal of Cosmetics and Dermatology 1, no. 1 (June 25, 2021): 10–11. http://dx.doi.org/10.55124/ijcd.v1i1.81.
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Glaucoma is the leading cause of irreversible blindness in the world. Currently, glaucoma affects more than 60 million people and it is expected to reach 76 million by 2020 (1).
Introduction
Glaucoma is the leading cause of irreversible blindness in the world. Currently, glaucoma affects more than 60 million people and it is expected to reach 76 million by 2020.1
There are two kinds of chronic glaucoma:
Open-angle glaucoma
Closed-angle glaucoma 2
Glaucoma is characterized as an optic neuropathy determined by structural changes and functional deficiencies. Primary glaucoma (open-angle) is the most prevalent in the general population (40-80 years 3-4%), and it constitutes the leading cause of irreversible vision loss in industrialized countries.3
Current pharmacological treatments seek to obtain optimal local tolerance, using preservative-free formulations in simple presentations or combinations, both in single-dose and multi-dose.
Contact dermatitis is caused by an ample inflammation which arises from the release of pro-inflammatory cytokines from keratinocytes, usually in response to chemical stimuli. Mainly, this causes alteration of the skin barrier, cellular changes at the epidermal level, and release of cytokines.4
Allergic contact dermatitis caused by eye medication is mainly attributed to active ingredients. But other excipient ingredients should also be analyzed in addition to the products on an "as is" basis.5
There is an entity called the Ocular Pharmacological Intolerance Syndrome (SIFO, in Spanish), which is an intolerance to the drop-based treatment for glaucoma which causes: conjunctival hyperemia, itching, sensation of foreign body presence, light sensitivity, lacrimation, and blepharitis. Exceptionally, these symptoms could also be present: superficial keratitis, deposits on the cornea, palpebral swelling, and blurred vision. SIFO in some of its degrees can also be caused by other topical drugs such as dyes, anesthetics, antibiotics, anti-inflammatories, antivirals, etc.
This paper presents a case of allergic contact dermatitis in a patient sensitized to timolol present in the ophthalmic preparations the patient used as a treatment for glaucoma.
Clinical Case
The patient is a 37-year-old male who was diagnosed 2 years ago with bilateral primary open angle glaucoma (POAG), with prescription of dorzolamide and a topical ß-adrenergic blocker (timolol) in drops, twice a day. In August of 2019, the patient seeked medical help for conjunctival hyperemia, itching, and inflammation of the eyelids of both eyes followed by erythematous dermatitis, which improved once the treatment was suspended. These symptoms repeated when the drug was used.
The patient was known to be hypertensive and received treatment with enalapril 10 mg and Aspirin 125 mg. The patient was not known to be asthmatic or allergic to drugs, nor was he known to be diabetic.
Thinking of a hypersensitivity reaction, a provocation test with timolol was performed and there was no immediate reaction. Then, provocation tests were performed, first with enalapril and later with aspirin. Both were negative for an immediate hypersensitivity reaction. Given the clinical situation of the patient and the risk of being without treatment, the patient was suggested to consult his ophthalmologist to look for another alternative treatment. While waiting for a response, the patient received the patch test with all the prescribed active ingredients of the drug used, through drops; The results were negative in the reading at 48 hours. At 96 hours the patient was called, who for work reasons could not attend the clinic, clarifying however that there had been no changes. After 7 days he was screened at the clinic, and no changes were found. In some cases where different beta-blockers for ophthalmic use are tested, and which have caused dermatitis in the eyelid area, negative results can be observed in the patch test. This occurs because the skin of the eyelids has greater penetrability than the skin of the back, where skin patches are usually applied.6,7 This would explain why the epicutaneous tests were negative for this patient, and the conjunctival provocation tests were positive.
Subsequently, provocation tests were performed using the provocation technique with increasing dilutions of 1/1000, 1/100, 1/10 and concentrated. As first dose tears were used as placebo, checking every 15 minutes the pulse of the patient as well as the pressure, the presence of pruritus, irritation, erythema, chemosis and epiphora. The patient remained in the hospital from 2 pm to 8 pm and the provocation was negative. The patient returned after 24 hours, and the provocation was once again negative. At 48 hours the reactions were positive (timolol maleate 0, 5%), with irritation, tearing, chemosis, and erythema in both eyelids.
Discussion
There are numerous substances contained in ophthalmic preparations responsible for producing true allergic contact reactions. The most important group responsible for this frequency is constituted by antimicrobial agents, and preservatives such as thimerosal, benzyl alcohol, benzalkonium chloride (BAC), ethylenediamine and parabens, among others.8,9
In recent years, there have been reports of contact dermatitis due to beta-blockers used in the treatment of glaucoma such as timolol 10, levobunolol 11, carteolol 12 or betaxolol 13. In all cases, eczematous-like reactions on the eyelids, blepharoconjunctivitis, itching with inflammation and edema, conjunctival chemosis, and blurred vision manifested with different intensity.
Timolol is a non-selective beta-blocker commonly more preferred than other agents in terms of efficacy, adverse effects, and cost. Its topical application can produce a foreign body sensation, pruritus, conjunctivitis and in some instances contact dermatitis.14
Several authors have suggested the possible existence of cross reactions between the different beta-blockers 15,16, so that the replacement of the drug involved in sensitization by another one from the same family would not proceed.
Although there are many medications and ophthalmic products which can cause adverse effects at the ocular level, fortunately in most cases these adverse effects reverse once the medication is discontinued.
However, when these adverse effects are not detected early, some reactions can prolong causing irreversible eye damage.17
Bibliography
Patch test with timolol alone, timolol dorzolamide and excipients, enalapril and ASA
Negative patch test at 72 hours
Positive conjunctival provocative test at 48 hours
3
Moga, Amir. "The Reaction and Type of Hypersensitivity." Journal Wetenskap Health 1, no. 1 (September 30, 2020): 21–25. http://dx.doi.org/10.48173/jwh.v1i1.12.
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The purpose of the study is to analyze the reaction and types of hypersensitivity. The study discusses the reaction of hypersensitivity occurs in individuals who have previously been exposed to an antigen that has created an immune response to it (sensitization). there are 4 groups of hypersensitivity reactions, namely Type I (anaphylactic reaction), type II (cytotoxic reaction), type III (immune complex reaction), type IV (slow type reaction). Hypersensitivity reactions can occur in two situations. first, the response to foreign antigens (microbes and non-infectious environmental antigens) which can cause tissue damage, especially if the reaction is repeated and uncontrolled. Second, the immune response can act directly against self-antigens (autologs) as a result of failure to tolerate self (self-tolerance).
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Schindewolf, Marc, Jochen Utikal, Edelgard Lindhoff-Last, Wolf-Henning Boehncke, and Ralf Ludwig. "Management of cutaneous type IV hypersensitivity reactions induced by heparin." Thrombosis and Haemostasis 96, no. 11 (2006): 611–17. http://dx.doi.org/10.1160/th06-04-0210.
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SummaryLocalized hypersensitivity reactions to subcutaneous heparin injections have been described since 1952. Yet, the incidence of these reactions, which are distinct from skin lesions associated with heparin-induced thrombocytopenia type II (HIT II), remains uncertain. However, in the last 10 years an increasing number of patients have been reported, leading to the assumption that cutaneous hypersensitivity reactions towards heparin are underreported. Clinically patients present with itching, sometimes infiltrated, and blistering erythemas at the injection sites of heparins. The diagnosis of cutaneous heparin allergy may, on the one hand, lead to delay of required medical or surgical treatment. On the other hand, delayed initiation of treatment may lead to a generalized eczematous reaction. Hence, from review of 223 cases of patients with cutaneous hypersensitivity reactions to heparin, we here summarize the clinical picture of cutaneous type IV allergic reactions, define risk factors on both the patient- and drug-side, and give an overview of principle therapeutic alternatives, as well as recommendations for treatment options for emergency and elective patients. As the proposed management of patients with cutaneous hypersensitivity reactions to heparin may have fatal consequences when applied in patients with HIT type II, diagnosis of skin lesions in heparin-treated patients needs to be precise.
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Melamed, Julian, and Wilfred N. Beaucher. "Delayed-type hypersensitivity (type IV) reactions in dental anesthesia." Allergy and Asthma Proceedings 28, no. 4 (July 1, 2007): 477–79. http://dx.doi.org/10.2500/aap.2007.28.3020.
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Watanabe, Keiko, Chisa Nakashima, Ayako Matsuo, Maiko Kato, Shigeto Yanagihara, Naoki Oiso, and Atsushi Otsuka. "Summary of COVID-19 vaccine-related erythema multiforme at Kindai University Hospital, Japan." Trends in Immunotherapy 6, no. 2 (December 14, 2022): 40. http://dx.doi.org/10.24294/ti.v6.i2.1653.
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The recently extended use of mRNA vaccines due to the COVID-19 pandemic has allowed the description of multiple cutaneous adverse events including local injection site reactions, urticaria, and morbilliform eruptions. COVID-19 vaccine-related cutaneous reaction patterns can be divided into type Ⅰ hypersensitivity reactions, type Ⅳ hypersensitivity reactions, autoimmune-related, and functional angiopathies based on pathogenesis. Erythema multiforme (EM), a type IV hypersensitivity reaction, has also been reported from several centers. We experienced the remarkable improvement of COVID-19 vaccine-related EM with systemic administration of prednisolone and summarized six cases experienced in our department.
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Dey, Mansi, Bibhu Prasad Mishra, and Abhijeeta Sahoo. "Use of levocetrizine in the management of type IV hypersensitivity to lidocaine: a case report." International Journal of Basic & Clinical Pharmacology 10, no. 12 (November 22, 2021): 1424. http://dx.doi.org/10.18203/2319-2003.ijbcp20214511.
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Lidocaine is a commonly used local anesthetic in the field of dentistry. It has been known to cause allergic reactions, mainly immunoglobulin (IgE)-mediated and T-cell –mediated type IV reactions, which require the use of alternative drugs without adverse effects. Here we present the case of a 29 year old female patient who developed Type IV hypersensitivity reaction in the vicinity of the injection site after the administration of lidocaine local anesthetic for performing exodontia. Levocetrizine tablet was prescribed in order to relieve the symptoms of the reaction. Levocetrizine is a selective, potent, oral histamine H(1) receptor antagonist that is used for the symptomatic treatment of allergic rhinitis and chronic idiopathic urticaria. It has been reported to be effective and generally well tolerated by the patients. In our case also it was able to cure Type IV hypersensitivity reaction to lidocaine without producing any adverse events. Apart from curing allergic rhinitis and urticaria, levocetrizine is a wonderful option for treating Type IV hypersensitivity reaction to a local anesthetic, and it hardly produces any adverse effect. More cases are required to be reported in the future in order to support this article.
8
Kunkeler, Lia, Cees Nieboer, and Derk P. Bruynzeel. "Type III and Type IV hypersensitivity reactions due to mitomycin C." Contact Dermatitis 42, no. 2 (February 2000): 74–76. http://dx.doi.org/10.1034/j.1600-0536.2000.042002074.x.
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Prodea, Mihaela, Eugen Radu Boia, Raluca Amalia Ceausu, Cosmin Librimir, Gheorghe Iovanescu, and Ovidiu Alexandru Mederle. "Lung Delayed Hypersensitivity. A case with particular features." Revista de Chimie 69, no. 8 (September 15, 2018): 2071–73. http://dx.doi.org/10.37358/rc.18.8.6476.
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Delayed hypersensitivity reactions are inflammatory reactions initiated by mononuclear leukocytes. These reactions are mediated by T cells and monocytes/macrophages rather than by antibodies. We describe a case of 50 years old man with lung type IV hypersensitivity. The case of lung delayed hypersensitivity presented has some particular histopathological and immunohistochemical features. The diagnosis of lung delayed type hypersensitivity requires analysis of correlation between clinic, radiographic, physiologic and pathologic criteria.
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Johnkennedy, Nnodim, Njoku-Obi Treasure, and Bako Hauwa. "Perspective of delayed Hypersensitivity: A review." Journal La Medihealtico 3, no. 2 (April 1, 2022): 142–45. http://dx.doi.org/10.37899/journallamedihealtico.v3i2.623.
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T cells enter tissues and are activated by antigen-presenting cells to produce cytokines that cause inflammation in the local area. In allergic contact dermatitis, drug eruptions, asthma, and autoimmune disorders, CD8+ T lymphocytes mediate DTH reactions. As an example of this type IV hypersensitivity, chronic DTH reactions, contact hypersensitivity, and hypersensitivity pneumonitis are all examples. Infiltration of an antigen-exposed region by Th1 cells and macrophages, which inflict tissue damage, is the primary cause of the delayed onset of symptoms. It has thus been outlined that this delayed hypersensitivity reaction.
11
Mori, Francesca, Francesca Saretta, Annamaria Bianchi, Giuseppe Crisafulli, Silvia Caimmi, Lucia Liotti, Paolo Bottau, et al. "Hypersensitivity Reactions to Monoclonal Antibodies in Children." Medicina 56, no. 5 (May 12, 2020): 232. http://dx.doi.org/10.3390/medicina56050232.
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Biologic drugs are widely used in pediatric medicine. Monoclonal antibodies (mAbs) in particular are a therapeutic option for rheumatic, autoinflammatory and oncologic diseases. Adverse drug reactions and hypersensitivity reactions (HSR) to mAbs may occur in children. Clinical presentation of HSRs to mAbs can be classified according to phenotypes in infusion-related reactions, cytokine release syndrome, both alpha type reactions and type I (IgE/non-IgE), type III, and type IV reactions, all beta-type reactions. The aim of this review is to focus on HSRs associated with the most frequent mAbs in childhood, with particular attention to beta-type reactions. When a reaction to mAbs is suspected a diagnostic work-up including in-vivo and in-vitro testing should be performed. A drug provocation test is recommended only when no alternative drugs are available. In selected patients with immediate IgE-mediated drug allergy a desensitization protocol is indicated. Despite the heavy use of mAbs in childhood, studies evaluating the reliability of diagnostic test are lacking. Although desensitization may be effective in reducing the risk of reactions in children, standardized pediatric protocols are still not available.
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Visch, Birgitte M., and Kees-Peter de Roos. "Allergies in Phlebology: A National Survey and Review of Literature." Phlebologie 51, no. 05 (October 2022): 237–44. http://dx.doi.org/10.1055/a-1736-5246.
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Abstract Background Type I and type IV hypersensitivity can play an important role in phlebology with potential severe consequences for patients and treatment results. Methods A review of literature was performed for allergic reactions in patients treated for venous insufficiency and venous leg ulcers (VLU), together with a study in the Dutch and European centre for adverse drug reactions. Besides, we performed a survey among 37 Dutch medical hospitals to investigate the incidence of treatment allergies. Results Hypersensitivity reaction is seen in 46–76% of patient with VLU; about 20% of these reactions are caused by wound dressings products. In 11 centres urticarial and respiratory complaints were seen and 3 systemic allergic reactions in phlebological treatments. In Europe 25 cases of systemic reactions were reported. Conclusion Patients with VLU with slow healing tendency should undergo allergy tests. Type I hypersensitivity with anaphylactic reaction, also to sclerosing fluid or tumescent, is very rare.
13
Ford, Megan K., and John R. Cohn. "Clopidogrel Hypersensitivity: Pathogenesis, Presentation and Diagnosis." Current Vascular Pharmacology 17, no. 2 (January 9, 2019): 110–12. http://dx.doi.org/10.2174/1570161116666181031143628.
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This paper provides an overview of the pathogenesis, presentation and diagnosis of clopidogrel hypersensitivity. The majority of clopidogrel hypersensitivity cases are due to a T cell mediated Gell and Coombs Type IV reaction. History, histology, and patch testing have shown consistency with a T cell mediated mechanism. Clopidogrel reactions most commonly present as a mild delayed maculopapular erythematous rash 5 to 10 days after introduction of the drug, and do not always require discontinuation of the drug. Severe cutaneous, systemic, and immediate adverse reactions to clopidogrel are rare. For the diagnosis of clopidogrel hypersensitivity, drug causality can be determined using patch testing, or for mild reactions, recurrence of symptoms after drug reintroduction, although neither are required for diagnosis.
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Isyroqiyyah, Nur Moya, Gatot Soegiarto, and Yuani Setiawati. "Profile of Drug Hypersensitivity Patients Hospitalized in Dr. Soetomo Hospital, Surabaya, Indonesia: Preliminary Data of 6 Months Observation." Folia Medica Indonesiana 55, no. 1 (April 9, 2019): 54. http://dx.doi.org/10.20473/fmi.v55i1.12558.
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Drug hypersensitivity is defined as an untoward response to medication which is noxious and unintended, and which occurs at doses normally used in human either for the prophylaxis, diagnosis, or therapy of disease or for the modification of physiological function. Drug hypersensitivity is common and may cause emergency condition until death. The incidence of drug hypersensitivity-related hospitalizations has usually been assessed within hospitals. The aim of this study is to determine the profile of drug hypersensitivity patients hospitalized at Dr. Soetomo Hospital in 6 months period from January to June 2016. This study was a descriptive retrospective study on medical records of drug hypersensitivity patients hospitalized in Dr. Soetomo Hospital in 6 months period. The patient’s demographic data, the type of hypersensitivity reaction, and the final outcome of the hospitalization were collected. Within the 6 months period, there were 16 drug hypersensitivity patients hospitalized in Dr. Soetomo Hospital. Most of them are female (56.25%), and aged between 46-55 years (25%). There were 4 patients (25%) with type I hypersensitivity: urticaria, angioedema and anaphylaxis; while type IV hypersensitivity occured in 12 patients (75%): Stevens-Johnson syndrome, Stevens-Johnson syndrome-Toxic Epidermal Necrolysis overlap, erythroderma, maculopapular drug eruptions, and DRESS. Most of the patients (87.5%) had favorable outcome after hospitalization. There were 16 patients with drug hypersensitivity reaction hospitalized in Dr. Soetomo Hospital, Surabaya in 6 months period. Most of them were female and had type IV hypersensitivity reactions.
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Isyroqiyyah, Nur Moya, Gatot Soegiarto, and Yuani Setiawati. "Profile of Drug Hypersensitivity Patients Hospitalized in Dr. Soetomo Hospital, Surabaya, Indonesia: Preliminary Data of 6 Months Observation." Folia Medica Indonesiana 55, no. 1 (January 14, 2021): 54. http://dx.doi.org/10.20473/fmi.v55i1.24387.
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Drug hypersensitivity is defined as an untoward response to medication which is noxious and unintended, and which occurs at doses normally used in human either for the prophylaxis, diagnosis, or therapy of disease or for the modification of physiological function. Drug hypersensitivity is common and may cause emergency condition until death. The incidence of drug hypersensitivity-related hospitalizations has usually been assessed within hospitals. The aim of this study is to determine the profile of drug hypersensitivity patients hospitalized at Dr. Soetomo Hospital in 6 months period from January to June 2016. This study was a descriptive retrospective study on medical records of drug hypersensitivity patients hospitalized in Dr. Soetomo Hospital in 6 months period. The patient’s demographic data, the type of hypersensitivity reaction, and the final outcome of the hospitalization were collected. Within the 6 months period, there were 16 drug hypersensitivity patients hospitalized in Dr. Soetomo Hospital. Most of them are female (56.25%), and aged between 46-55 years (25%). There were 4 patients (25%) with type I hypersensitivity: urticaria, angioedema and anaphylaxis; while type IV hypersensitivity occured in 12 patients (75%): Stevens-Johnson syndrome, Stevens-Johnson syndrome-Toxic Epidermal Necrolysis overlap, erythroderma, maculopapular drug eruptions, and DRESS. Most of the patients (87.5%) had favorable outcome after hospitalization. There were 16 patients with drug hypersensitivity reaction hospitalized in Dr. Soetomo Hospital, Surabaya in 6 months period. Most of them were female and had type IV hypersensitivity reactions.
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Sameed, Muhammad, Christine Nwaiser, Prashant Bhandari, and Sarah A. Schmalzle. "Meropenem-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a patient with known type IV penicillin hypersensitivity." BMJ Case Reports 12, no. 8 (August 2019): e230144. http://dx.doi.org/10.1136/bcr-2019-230144.
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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.
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Muthupalaniappen, Leelavathi, and Adawiyah Jamil. "Prick, patch or blood test? A simple guide to allergy testing." Malaysian Family Physician 16, no. 2 (May 31, 2021): 19–26. http://dx.doi.org/10.51866/rv1141.
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This article provides information on allergy testing and serves as a simple guide for physicians who are considering using allergy testing as a step in patient management. Basic principles of allergy testing, indications for testing, and how and when to choose a suitable allergy test are discussed. Allergy testing in general refers to evaluation of either type I or type IV hypersensitivity reactions. The type I (immediate) reaction is evaluated using the skin prick test (in vivo) or serum IgE (in vitro) test methods, while the type IV (delayed) reaction is determined via the skin patch test method. The allergens responsible for a specific reaction can be identified from allergy testing, and this information is useful in administering avoidance measures. Appropriate treatment of allergic reactions along with allergen avoidance ensure a successful treatment outcome and prevent future reactions.
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Kriger, Stephen J., Shontal A. Behan, Parth J. Bhakta, Nicholas G. Bruning, Brennan A. Menninger, and Mark C. Razzante. "Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Medial Displacement Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis." Journal of the American Podiatric Medical Association 106, sp1 (January 1, 2016): 11. http://dx.doi.org/10.7547/8750-7315-2016.1.kriger.
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INTRODUCTION AND OBJECTIVES: Due to its inert character and desired biocompatibility, titanium (Ti) implants have been universally accepted as safer alternatives to the previous conventional orthopedic hardware implants. However, a recent emergence of Type IV hypersensitivity reactions to Ti have displayed symptoms that include eczema, contact dermatitis, prolonged fever, sterile osteomyelitis, and impaired fracture and wound healing. The following case presents a patient with postoperative incision dehiscence and devascularization of cortical surfaces in contact with Ti hardware after undergoing a medial displacement calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis. To our knowledge, this is the only reported case of an allergic reaction to a Ti implant in the foot or ankle in the United States. METHODS: Diagnostic tools to confirm a Ti hypersensitivity reaction include a patch test and lymphocyte transformation test. The lymphocyte transformation test can be utilized if a false negative patch test is suspected. Potential treatment options include immunosuppressants, removal or substitution of the Ti hardware, and external fixation. RESULTS: In this case, the patient's allergy to Ti was confirmed with a patch test, and all hardware was subsequently removed with no other complications. CONCLUSIONS: A hypersensitivity reaction to Ti should remain a differential diagnosis for a patient presenting with symptoms such as prolonged fever, contact dermatitis, sterile osteomyelitis, and impaired wound healing. Preoperative diagnostic tools, such as the patch test, can be utilized to prevent allergic reactions from occurring. Treatments for Ti hypersensitivity should be tailored to fit the patient's needs and can include removal or substitution of the Ti hardware, external fixation, and immunosuppressants.
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Kämpgen, Eckhart, Thomas Bürger, Eva-B. Bröcker, and C. Eberhard Klein. "Cross-reactive Type IV hypersensitivity reactions to benzodiazepines revealed by patch testing." Contact Dermatitis 33, no. 5 (November 1995): 356–57. http://dx.doi.org/10.1111/j.1600-0536.1995.tb02060.x.
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Pilar Hernández, Alfonso, Mahave Idoia González, Oribe Irene Vidal, del Pozo Gil Mª Dolores, Díaz Mónica Venturini, and Labairu Teófilo Lobera. "Maculopapular delayed exanthema due to ranitidine." Annals of Dermatological Research 4, no. 1 (December 23, 2020): 014–16. http://dx.doi.org/10.29328/journal.adr.1001012.
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Ranitidine is a widely used drug in Europe and its intake is usually well tolerated. Hypersensitivity reactions due to ranitidine are uncommon. The immediate mild reactions type are the most prevalent. In some special cases a delayed type reaction such as contact dermatitis or severe reactions with systemic involvement have been reported. In the present paper, a case report of a 78-year old patient who experienced a maculopapular eruption after 7 days of oral treatment with ranitidine is described. Patch tests were performed twice with ranitidine with positive results confirming the diagnosis. In order to discard a double sensitization and a possible cross-reactivity phenomenon, patch test was performed once with famotidine, with a negative result. This is the first maculopapular exanthema reported as type IV hypersensitivity reaction to ranitidine confirmed by patch testing. Moreover, there are only two reported cases showing a double sensitization to ranitidine and to other H2-receptor antagonists by patch testing after a delayed reaction due to ranitidine, the other being H2-receptor antagonists involving cimetidine and nizatidine, not famotidine.
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Steward, M. W. "Immunopathological mechanisms in the induction of parasitic diseases with particular reference to type III hypersensitivity reactions." Parasitology 94, S1 (January 1987): S139—S158. http://dx.doi.org/10.1017/s0031182000085863.
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During the primary immune response to an infectious agent, specific memory cells are generated which enable the immune system to respond more rapidly and efficiently to re-exposure to the same agent. Under normal circumstances, this acquired resistance leads to the effective elimination of the agent, and recovery. However, under certain circumstances these secondary infections, rather than aiding recovery, actually produce tissue damage and often contribute to the disease process. This stage has been termed hypersensitivity and such hypersensitivity reactions play an important role in the immunopathology of several diseases. Coombs & Gell (1963) have classified hypersensitivity into four types of reaction. Types I, II and III involve antibody-mediated processes whereas type IV is mediated solely by lymphocytes. Many parasitic infections have characteristics which would appear to predispose the host to the development of hypersensitivity states and consequent immunopathology. These include (1) the chronicity of the infections, (2) the release of parasite antigens in large amounts and their persistence in the circulation and host tissues, (3) the sharing of antigens between parasite and host and (4) the ability of the parasite to damage host tissues and alter their antigenicity. However, direct evidence that these mechanisms lead to the development of immunopathology in parasitic infections is limited. In this article, these four types of hypersensitivity will be briefly discussed in the context of the immunopathology following parasite infection. There then follows a more extensive consideration of type III hypersensitivity with particular emphasis on the mechanisms underlying the development of immune-complex mediated disease.
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Oktarina, Dyah Ayu Mira, Maria Sophiati, Erinda Maharani Rambu Moha, Fajar Waskito, and Haryanto Soebono. "A Five-Year Review of Adverse Cutaneous Drug Reaction in a Tertiary Care Hospital in Yogyakarta, Indonesia." Berkala Ilmu Kesehatan Kulit dan Kelamin 33, no. 3 (November 30, 2021): 150. http://dx.doi.org/10.20473/bikk.v33.3.2021.150-155.
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Background: The prevalence of adverse drug reactions is likely to increase, and it is associated with increased usage of various drugs. Adverse Cutaneous Drug Reaction (ACDR) is the most frequent adverse drug reaction (30–45%). In Indonesia, the study on the prevalence of ACDR is still limited. Purpose: This study investigated the prevalence, clinical features, causative agents, and mortality rate of ACDR with a type-IV hypersensitivity reaction among patients attending the Department of Dermatology and Venereology in Dr. Sardjito Hospital, Yogyakarta. Methods: This retrospective study was conducted examining medical records undertaken for five years (2011–2015). Of 68,375 patients medicated in the Department of Dermatology and Venereology, 397 patients were diagnosed as ACDR with a type-IV hypersensitivity reaction. Detailed history, including age, sex, past history, and family history of drug reaction taken by the patient, were obtained. Patch testing was done wherever feasible. Result: Of 68,375 patients, 397 patients were included in ACDR with type-IV hypersensitivity (0.58%), giving a 5% of mortality rate. The mean age of the patients was 40.42 years (±16.30; range 18 to 89 years). The female to male ratio was 1.1: 1. The Maculopapular rash was the most common ACDR manifestation (50.88%), followed by Stevens-Johnson Syndrome (13.85%), Fixed Drug Eruption (12.85%), and Drug Reaction with Eosinophilia and Systemic Symptoms (10.08%). The most common causative agents were beta-lactam (16.55%), NSAIDs (12.18%), and acetaminophen (8.62%). Conclusion: Prescription of those drugs should be considered carefully so the incidence of ACDR can be reduced.
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Yoo, Michael, and Brandon Carius. "Mango Dermatitis After Urushiol Sensitization." Clinical Practice and Cases in Emergency Medicine 3, no. 4 (September 30, 2019): 361–63. http://dx.doi.org/10.5811/cpcem.2019.6.43196.
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Prior exposure to poison ivy and poison oak, which are plants in the Anacardiacea family and contain high levels of urushiol, appear to be a risk factor for delayed hypersensitivity reactions to mango fruits. Cross-sensitization between these plants and mangos is believed to be secondary to an overlap in the urushiol antigen and 5-resorcinol, found predominately in mango peels. This unique combination of sensitization and reaction constitutes a type IV hypersensitivity response, mediated and driven by T cells reacting to similar antigens. We present a case of an otherwise healthy man, with a remote history of poison ivy exposure, who presented with a delayed but significant reaction to mango fruit. Obtaining the patient’s history of prior plant exposures and reactions was key to isolating the likely underlying causation of his presentation.
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Sommer, S., S. M. Wilkinson, M. H. Beck, J. S. C. English, D. J. Gawkrodger, and C. Green. "Type IV hypersensitivity reactions to natural rubber latex: results of a multicentre study." British Journal of Dermatology 146, no. 1 (January 2002): 114–17. http://dx.doi.org/10.1046/j.1365-2133.2002.04565.x.
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Kolokitha, Olga Elpis, and Evangelia Chatzistavrou. "A Severe Reaction to Ni-Containing Orthodontic Appliances." Angle Orthodontist 79, no. 1 (January 1, 2009): 186–92. http://dx.doi.org/10.2319/111507-531.1.
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Abstract Exposure to nickel-containing orthodontic appliances may cause intra- or extraoral allergic reactions. Nickel is the most typical antigen implicated in causing allergic contact dermatitis, which is a Type IV delayed hypersensitivity immune response. This report presents an unusual reaction to nickel during the orthodontic treatment of an adult female patient. The patient had no previous history of allergy and had been wearing fixed metal upper appliances while in orthodontic treatment to assist the eruption of her impacted teeth. The adverse hypersensitivity reactions appeared only after the surgical exposure and included severe signs of eczematic and urticarial reactions of the face with redness, irritation, itching, eczema, soreness, fissuring, and desquamation as well as intraoral diffuse red zones. Diagnostic patch testing performed by the allergist revealed sensitization to nickel (++++ score). Treatment was achieved with nickel-free appliances.
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Hafizi, Ikmal, Widjijono Widjijono, and Marsetyawan HNE Soesatyo. "Perbandingan Hipersensitivitas Tipe IV Akibat Paparan Remanium Gm800 Dan Stainless Steel 316L." Jurnal Material Kedokteran Gigi 6, no. 1 (March 1, 2017): 48. http://dx.doi.org/10.32793/jmkg.v6i1.264.
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Stainless steel and cobalt chromium is a metal that is used in dentistry. Stainless steel (SS) 316L has good corrosion resistance, but there are still many cases of hypersensitivity due to the use of such materials. Remanium GM800 is a cobalt-based alloy which is relatively mild with the advantages of having a high fracture resistance, high modulus of elasticity and resistance to corrosion. The research aims to know type IV hypersensitivity reactions for cobalt chromium GM800 applications compared with 316L Stainless steel. The research was conducted through the test GPMT (Guinea Pig Maximization Test). The pre-research phase does CoCr patch/SS/control application to 3 guinea pigs of each group with concentrations of 5%, 10%, 20%, 40%, and 80%. Primary research begins with intradermal induction on the backs of guinea pigs for 7 days with a suspension of A (50% FCA emulsion dan 50% Propylene glycol), B (SS/CoCr/blank dan Propylene glycol) and C (50% SS/CoCr/blank suspension and 50% FCA) on the left and right backs of guinea pigs. On the 8th day induction results topical concentration of 40% for 24 hours, then opened to see the reaction and closed again for 48 hours. After that, the research was continued with challenge phase by attaching patch 5% concentration for 14 days. On the 28th day was observed erythema and edema on the skin of guinea pigs followed by sacrifice in order to obtain specimen to do immunohistochemical staining by ED antibodies. The result showed 316L SS cause 40% of the samples sensitized that were grouped in moderate classification, while CoCr GM800 cause 20% of the samples sensitized so classified in the mild classification in triggering type IV hypersensitivity reaction. Histopathology examination showed that 42% of the visual field SS 316L specimen expressed macrophages, while only 28% expressed macrophages in CoCr GM800 specimen. The conclusion of this study CoCr GM800 trigger type IV hypersensitivity reaction is lower than SS 316L.
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Boruah, Geetismita, Ashvini Kumar M, Nataraj HR, and Lohith BA. "Ayurvedic Management of Upanaha Induced Contact Dermatitis, a Type IV Delayed Hypersensitivity Reaction- A Case Report." Journal of Ayurvedic and Herbal Medicine 8, no. 3 (September 30, 2022): 169–72. http://dx.doi.org/10.31254/jahm.2022.8306.
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Adverse drug reactions (ADR) are undesirable side effects of a pharmacological therapy that have a significant impact on an individual's quality of life. A 79-year-old female presented to the Panchakarma OPD of Sri Dharmasthala Manjunatheshwara College of Ayurveda and Hospital, Hassan, with complaints of itching, burning sensation, rash, and swelling in both knees for three days. She was diagnosed with an Upanaha induced contact dermatitis, specifically a Type IV delayed hypersensitivity reaction. The symptoms were completely resolved after a 15-day therapeutic strategy with Sudarshan Ghana vati, Laghusootshekhar rasa, and local application of Shatadhouta ghrita and Aloe Vera (Aloe Berdensis).
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Nigam, Anant Gopal, Ankita Beniwal, Shefali Chaturvedi, and Tanmay Bhatt. "Eugenol Hypersensitivity in Pediatric Dental Patient: A Rare Case Report." Journal of Mahatma Gandhi University of Medical Sciences and Technology 1, no. 2 (2016): 68–70. http://dx.doi.org/10.5005/jp-journals-10057-0017.
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ABSTRACT Eugenol is a phenolic compound commonly used in dentistry as an analgesic and anti-inflammatory drug. Zinc oxide eugenol is an important root canal filling material in primary teeth with excellent documented success. Its cytotoxic effect is documented in some cases due to production of zinc eugenolate which is highly unstable and induces type IV hypersensitivity reactions and even generalized anaphylactic symptoms. But, the case reports documenting immediate hypersensitivity reaction to eugenol are very rare. This was a case of type I immediate hypersensitivity reaction to eugenol in a 3 years old pediatric patient. During the full mouth rehabilitation under general anesthesia, hard indurated swelling of lower lip was observed at the time of obturation of mandibular primary teeth. The procedure was stopped immediately suspecting an allergic response which was later confirmed to be eugenol allergy by patch test. Hence, it is important to evaluate all local allergies even if the patient fails to report allergy history. How to cite this article Beniwal A, Chaturvedi S, Bhatt T, Sharma A, Nigam AG. Eugenol Hypersensitivity in Pediatric Dental Patient: A Rare Case Report. J Mahatma Gandhi Univ Med Sci Tech 2016;1(2):68-70.
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Wąsik, Magdalena, Katarzyna Nazimek, Bernadeta Nowak, Philip W. Askenase, and Krzysztof Bryniarski. "Delayed-Type Hypersensitivity Underlying Casein Allergy Is Suppressed by Extracellular Vesicles Carrying miRNA-150." Nutrients 11, no. 4 (April 23, 2019): 907. http://dx.doi.org/10.3390/nu11040907.
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In patients with non-IgE-mediated milk allergy, a cellular mechanism of delayed-type hypersensitivity (DTH) is considered. Recent findings prove that cell-mediated reactions can be antigen-specifically inhibited by extracellular vesicles (EVs) carrying miRNA-150. We sought to establish a new mouse model of DTH to casein and test the possibility of antigen-specific suppression of the inflammatory reaction. To produce soluble antigenic peptides, casein was subjected to alkaline hydrolysis. DTH reaction to casein was induced in CBA, C57BL/6, and BALB/c mice by intradermal (id) injection of the antigen. Cells collected from spleens and lymph nodes were positively or negatively selected and transferred to naive recipients intravenously (iv). CBA mice were tolerized by iv injection of mouse erythrocytes conjugated with casein antigen and following id immunization with the same antigen. Suppressive EVs were harvested from cell cultures and serum of tolerized donors by means of ultrafiltration and ultracentrifugation for further therapeutic utilization. The newly established mouse model of DTH to casein was mediated by CD4+ Th1 cells and macrophages, while EVs produced by casein-tolerized animals effectively suppressed effector cell response, in an miRNA-150-dependent manner. Altogether, our observations contribute to the current understanding of non-IgE-mediated allergy to casein and of the possibilities to downregulate this reaction.
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Doyle, E., I. Mavrikakis, E. J. Lee, R. Emerson, A. J. Rainey, and G. P. Brittain. "Type IV Hypersensitivity Reactions to Upper Lid Gold Weight Implants—Is Patch Testing Necessary?" Orbit 24, no. 3 (January 2005): 205–10. http://dx.doi.org/10.1080/01676830590930706.
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Sullivan, A., J. Watkinson, J. Waddington, B. K. Park, and D. J. Naisbitt. "Implications of HLA-allele associations for the study of type IV drug hypersensitivity reactions." Expert Opinion on Drug Metabolism & Toxicology 14, no. 3 (February 22, 2018): 261–74. http://dx.doi.org/10.1080/17425255.2018.1441285.
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KODA, AKIHIDE. "Inhibition of Hypersensitivity Reactions by Saiboku-to (TJ-96), Particularly on Type IV Reaction." Annals of the New York Academy of Sciences 685, no. 1 Immunomodulat (June 1993): 543–48. http://dx.doi.org/10.1111/j.1749-6632.1993.tb35917.x.
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Zhukova, D. G., E. S. Fedenko, A. A. Yudin, and O. Y. Rakhimova. "PERIOPERATIVE IMMEDIATE DRUG HYPERSENSITIVITY: CLINICAL FEATURES, DIAGNOSTICS, RISK ASSESSMENT." Russian Journal of Allergy 11, no. 6 (December 15, 2014): 9–19. http://dx.doi.org/10.36691/rja486.
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Background. To evaluate clinical features and to develop the diagnostic algorithm of perioperative drug’s hypersensitivity reactions. Methods. 40 patients who presented perioperative immediate drug’s hypersensitivity reactions were studied in the Central Clinical hospital of the Russian Academy of sciences during 2010-2012. The diagnostic protocol consisted of 2 steps: at the 1 step (during the acute clinical manifestation period) a case history, grade of severity of immediate hypersensitivity reactions, serum tryptase levels have been studied; at the 2 step (6-12 weeks after symptoms were over) inhibition test of natural emigration of leukocytes by Ado, sublingual, skin tests and drug provocation tests have been performed. Results. Clinical manifestations of drugs hypersensitivity were as follows: hypersensitivity reactions grade I (isolated cutaneous manifestations) - in 20 patients (50%), anaphylactic-type reactions - in 20 patients (50%): grade II (moderate anaphylaxis) - in 13 patients (32,5%), grade III (severe life-threatening anaphylaxis) - in 6 (15%), and grade IV (cardiac and respiratory arrest) - in 1 patient (2,5%). Positive tests at least with 1 drug had 28 patients (70%): neuromusculars blockers (22,5%); antibiotics (22,5%); lidocaine (10%); amidotrizoate (7,5%); NSAID (7,5%). Other 12 patients had negative tests (30%) with all suspected agents and moderate clinical symptoms if to compare with others 28 patients (p
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Starks, David, Deborah Prinz, Amy Armstrong, Lindsay Means, Steven Waggoner, and Robert DeBernardo. "Management of a Type I Hypersensitivity Reaction to IV Etoposide in a Woman with a Yolk Sac Tumor: A Case Report." Case Reports in Obstetrics and Gynecology 2011 (2011): 1–2. http://dx.doi.org/10.1155/2011/837160.
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Type I hypersensitivity reactions to intravenous administration of etoposide are extremely rare. Etoposide is an essential component of several chemotherapy regimens used in gynecologic oncology, and discontinuation of this drug during a course of treatment should only be due to severe patient intolerance. We report the successful use of intravenous etoposide phosphate as a substitute drug in a patient with a yolk sac tumor who manifested a Type I hypersensitivity to intravenous etoposide. The patient ultimately completed all 4 cycles of bleomycin, etoposide, cisplatin (BEP) using etoposide phosphate as a substitute drug.
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Zairi, Fahed, Jean Michel Remacle, Mohamed Allaoui, and Richard Assaker. "Delayed hypersensitivity reaction caused by metal-on-metal total disc replacement." Journal of Neurosurgery: Spine 19, no. 3 (September 2013): 389–91. http://dx.doi.org/10.3171/2013.6.spine121010.
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The authors report the case of a 53-year-old woman who underwent placement of a metal-on-metal total disc replacement (TDR) device for the treatment of discogenic back pain. The initial postoperative course was normal, but 2 months after surgery she started to complain of a recurrence of pain and she progressively developed cauda equina syndrome. Radiological and biological findings showed an inflammatory polyneuropathy associated with an epidural mass. A diagnosis of cell-mediated hypersensitivity reaction (Type IV) was made after patch testing showed positive reactions for 1% cobalt chloride and chromium. A decision was made to remove the TDR device and to perform a circumferential fusion. This report is intended to inform the reader that systemic metal release and hypersensitivity reaction are possible complications of metal-on-metal TDR.
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Lavrenko, A. V., Ya M. Avramenko, O. A. Borzykh, and I. P. Kaidashev. "ENGLISH VERSION: PERSONALIZED DESENSITIZATION WITH ACETYLSALICYLIC ACID IN PATIENTS WITH HYPERSENSITIVITY TO NON-STEROIDAL ANTI-INFLAMMATORY DRUGS." Medical and Ecological Problems 24, no. 1-2 (April 29, 2020): 40–43. http://dx.doi.org/10.31718/mep.2020.24.1-2.09.
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Aims: Hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) has various mechanisms and represents different clinical syndromes from anaphylaxis to severe bronchospasm. The prevalence of aspirin hypersensitivity among patients with asthma and nasal polyps reaches 25.6%. Respiratory reactions associated with aspirin or other NSAIDs are not immunological. The basis of these reactions is non-allergic hypersensitivity of the cross-reactive type. Desensitization followed by long-term aspirin therapy is an effective method of treating hypersensitivity to aspirin or other NSAIDs. Using aspirin 600-1200 mg/day can significantly alleviate the symptoms of asthma, allergic rhinitis. Methods: We successfully applied aspirin desensitization for method of patients with hypersensitivity to NSAIDs. According to the method, an hour before the desensitization, daily montelukast 10 mg was taken orally, then aspirin every 3 hours. Results: Three patients underwent desensitization of aspirin. The dose was selected individualy depending on the clinical manifestations of drug-induced adverse reactions (AR). ARs during desensitization were treated by iv dexamethasone administration. Subsequent doses did not cause AR. Doses of aspirin were increased to a maximum of 1250 mg daily, and were continued for the long-term use. Conclusion: It is possible to conclude that the initial dose of aspirin should be 16-40mg; it is possible to increase the dose if the initial dosage is well tolerated; symptoms of moderate intolerance are treated by 4-8 mg iv dexamethasone; prior to desensitization, we recommended to use montelukast 10 mg, it is safe to practice desensitization of aspirin according to a personalized technique by a specialist in an intensive care unit.
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Taylor, James S., and Yung-Hian Leow. "Cutaneous Reactions to Rubber." Rubber Chemistry and Technology 73, no. 3 (July 1, 2000): 427–85. http://dx.doi.org/10.5254/1.3547600.
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Abstract The three major adverse cutaneous reactions to rubber include natural rubber latex allergy, irritant contact dermatitis and allergic contact dermatitis. An overview of relevant aspects of the types of natural and synthetic rubber, rubber production, and specific chemicals used in compounding and vulcanization, as well as latex proteins is essential to an understanding of these reactions. Natural rubber latex allergy is a type I, IgE mediated, immediate hypersensitivity reaction to one or more proteins present in natural rubber latex with clinical manifestations ranging from contact urticaria to allergic rhinitis, asthma, and anaphylaxis. Over the past decade, natural rubber latex allergy has become a major medical, occupational health, and medicolegal problem. Individuals at highest risk are patients with spina bifida and health care workers. Diagnosis is based largely on clinical history and examination, and serologic and intracutaneous testing. Irritant contact dermatitis is non-immunologic and is the most common cutaneous reaction to rubber. Cumulative exposure to low-grade irritants impairs the barrier function of the skin and allows penetration of potential irritants and allergens. Diagnosis is based on history of exposure to known irritants, cutaneous examination, and exclusion of allergy. Allergic contact dermatitis is a type IV cell mediated, delayed hypersensitivity reaction which occurs primarily from exposure to rubber chemicals either directly or from residual amounts present in rubber products. Most cases present with an eczematous dermatitis, but purpura, lichenoid dermatitis, and depigmentation occasionally occur. Diagnosis is made on the basis of history, examination, and epicutaneous patch testing with rubber chemicals and rubber products. Treatment is with allergen and irritant avoidance and substitution, environmental control, personal protective equipment and topical and systemic pharmacologic therapy. A unified approach is needed in the diagnosis and treatment of adverse cutaneous reactions to rubber and it is important to remember that some patients may have both contact dermatitis and natural latex allergy. Determining the bioavailability and elicitation threshold of rubber allergens may be helpful in reducing allergic reactions from consumer and industrial rubber products.
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Kobayashi, Takaaki, Tadahiko Masaki, Koji Kogawa, Hiroyoshi Matsuoka, and Masanori Sugiyama. "Hemoptysis and Acute Respiratory Syndrome (ARDS) as Delayed-Type Hypersensitivity After FOLFOX4 Plus Bevacizumab Treatment." International Surgery 98, no. 4 (October 1, 2013): 445–49. http://dx.doi.org/10.9738/intsurg-d-12-00020.1.
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Abstract As there have been many multidrug regimens introduced in colorectal cancer treatment, hypersensitivity is more often encountered than in the past. Though most allergic adverse events of oxaliplatin are mainly classified as type I reaction, a limited number of case reports of type IV reaction (delayed-type hypersensitivity) have been reported. A 73-year-old man was hospitalized for receiving the third cycle of FOLFOX4 plus bevacizumab. Forty-two hours after administration, he had dyspnea and hemoptysis. Acute respiratory distress syndrome was suspected, and the patient underwent mechanical ventilation and steroid pulse therapy. Delayed-type hypersensitivity is induced by induction of inflammation via IL-1, TNF-α and IL-6. The serum level of IL-6 in patients with advanced colorectal cancers is usually greater than the normal range. Therefore, delayed-type hypersensitivity may be easily induced in those patients. We should pay special attention to delayed-type hypersensitivity in advanced colorectal cancer patients undergoing FOLFOX treatment.
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Lo Feudo, Chiara Maria, Luca Stucchi, Elena Alberti, Bianca Conturba, Enrica Zucca, and Francesco Ferrucci. "Intradermal Testing Results in Horses Affected by Mild-Moderate and Severe Equine Asthma." Animals 11, no. 7 (July 13, 2021): 2086. http://dx.doi.org/10.3390/ani11072086.
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Equine asthma is an inflammatory respiratory disorder, classified as mild-moderate (MEA) and severe (SEA). SEA is characterized by recurrent exacerbations, consisting of dyspnea, coughing and exercise intolerance; MEA causes poor performance, occasional cough and mucus hypersecretion. Although a precise pathogenesis is not completely understood, allergic mechanisms are considered an important pathophysiological feature of equine asthma. In equine medicine, intradermal testing (IDT) is effective in identifying hypersensitivity to specific allergens. However, to date, the studies about IDT in asthmatic horses obtained contradictory results. This study aims to evaluate IDT responses in MEA and SEA horses and to identify the most significant allergens. Thirty-eight asthmatic horses were enrolled and underwent IDT using 50 allergens; reactions were evaluated at 30 min, 4, 24 and 48 h and were assigned a score from 0 to 4. In SEA horses, the most frequent and strongest reactions were observed at 30 min and 4 h, suggesting the involvement of type I hypersensitivity; in MEA horses, also type IV hypersensitivity seemed to play a major role. Insects, Dermatophagoides spp. and dog epithelium induced in MEA and SEA horses the most significant hypersensitivity responses and could therefore be considered as the main allergenic antigens in our geographic area.
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Xia, Shijia. "Hypersensitivity Pneumonitis: Perspective in Diagnosis and Pathology." E3S Web of Conferences 185 (2020): 03002. http://dx.doi.org/10.1051/e3sconf/202018503002.
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Hypersensitivity pneumonitis (HP) is the excessive immune response in the lung parenchyma (alveoli, terminal bronchiole, interstitium), resulting from repeated exposure to a variety of antigens. From the clinical point of view, HP can be divided into acute, subacute, or chronic forms. Only few of the exposed individuals develop HP, but workers in environments contaminated by organic dust are at a higher risk. The pathogenesis of HP is complex and still under investigation. Previous research suggests that both type III and IV hypersensitivity reactions are involved. The main treatment is the removal of antigen. Therefore, research of causative agents and pathogenesis is of outstanding importance not only for early diagnosis but also the better treatment of HP.
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Schaer, Michael, Gareth J. Buckley, Bobbi J. Conner, Laura C. Cuddy, Alessio Vigani, Allison E. Vansickle, James G. Coisman, Deanna R. DeVuyst, and Carsten Bandt. "Severe Pit Viper Envenomation with Extended Clinical Signs and Treatment Complications in a Dog." Journal of the American Animal Hospital Association 51, no. 5 (September 1, 2015): 329–37. http://dx.doi.org/10.5326/jaaha-ms-6234.
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This manuscript describes the extended clinical abnormalities that can occur in severe snake envenomation and the clinical signs associated with antivenom hypersensitivity in a 3 yr old dog. Treatment consisted of IV fluid therapy, analgesics, a vasopressor, cardiac antiarrhythmia drugs, and polyvalent pit viper antivenom. Following initial response to treatment, relapse of clinical signs occurred. Most interesting was the recrudescence of clinical signs on day 7 that may have been caused by the release of deposited venom during surgical debridement of necrotic skin. The resulting extensive clinical signs required multiple vials of antivenom (22 vials over a 7 day period). Both F(ab′)2 antivenom and antivenin (Crotalidae) polyvalent were used in this dog because of availability logistics. It is thought that this large amount of antivenom resulted in type I (anaphylaxis) and type III hypersensitivity (serum sickness) reactions. The dog made a complete clinical recovery. This description of extended, fluctuating clinical abnormalities that were associated with envenomation together with the development of hypersensitivity reactions that were presumably secondary to antivenom administration is information that can be useful for the management of patients afflicted with severe pit viper envenomation.
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Holmstrup, P. "Oral Mucosa and Skin Reactions Related to Amalgam." Advances in Dental Research 6, no. 1 (September 1992): 120–24. http://dx.doi.org/10.1177/08959374920060010401.
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Documented cases of oral mucosa and skin affections related to amalgam restorations are rare, although the exact incidence is unknown. Lesions of the oral mucosa may be due to specific immunologic or non-specific toxic reactions toward products generated from restorations. The immunologic reaction most probably involved in mucosal affections related to amalgam is the delayed or cell-mediated (type IV) reaction. Such reactions are seen in contact allergy, and the term "contact lesions of the oral mucosa" has been used. There is a much lower tendency of sensitization through mucous membranes than through skin, and it is questionable whether mercury released from amalgam restorations is able to sensitize a patient. A chronic toxic reaction may be established due to repeated or constant influence to toxic agents in low concentrations over long periods. Such reactions are most frequently localized to the contact zone with the toxic agent. Chronic toxic reactions may possibly be seen in areas of the oral mucosa in direct contact with amalgam fillings. Since the clinical features of these lesions do not differ from those of lesions due to contact hypersensitivity, the diagnosis is obtained by exclusion based on a negative patch test.
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Khosravi, Mohsen. "A Possible Type IV Hypersensitivity Reaction to Older Antiepileptic Drugs During and After Recovery from COVID-19 Infection." Pharmacopsychiatry 55, no. 01 (November 10, 2021): 58–59. http://dx.doi.org/10.1055/a-1678-7429.
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To the EditorNearly two years after the onset of the coronavirus disease 2019 (COVID-19) pandemic, healthcare workers face new and unexpected complications. Although accelerating the vaccination process in recent months has reduced the incidence and mortality of the COVID-19 infection, the general population (particularly vulnerable groups) remains at risk of new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. Over the last two months, Iran has encountered the fifth wave of the COVID-19 pandemic, i. e., the B.1.617.2 (Delta) variant of the SARS-CoV-2, with faster infectiousness and higher severity and mortality among hospitalized patients 1. Although fever, cough, and expectoration are the most common clinical features of COVID-19, recent studies have indicated an increasing number of skin manifestation reports in the disease. Besides, there is growing evidence that underlying SARS-CoV-2 infection may increase the risk of adverse drug reactions 2. However, the enduring concern in our medical centers in recent days is a raised incidence of Stevens-Johnson syndrome (SJS) in recovered COVID-19 patients following monotherapy with older antiepileptic drugs (0.004 vs. 0.0008% – i. e., 5 times higher than the pre-COVID-19 period) 3. It is worth noting that these patients did not have any history of SJS/toxic epidermal necrolysis (TEN) or additional etiopathogenic factors, including infections, genetic factors (particularly HLA-B*1502 allele), and malignancy. Furthermore, for many years before developing the COVID-19 and recovering from it, they had been treated with the above drugs without showing any cutaneous hypersensitivity reactions. These observational findings raise two important questions: (i) Could a history of the COVID-19 infection be a potential risk factor for type IV hypersensitivity reactions to older antiepileptic drugs? (ii) If so, what are its mechanisms of action?
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Fajardo, Kevin A., and Wendi E. Wohltmann. "The Impact of Aeroallergens on Military Readiness: A Case Report." Military Medicine 184, no. 11-12 (May 24, 2019): e945-e947. http://dx.doi.org/10.1093/milmed/usz106.
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Abstract Seasonal aeroallergens commonly cause allergic conjunctivitis, rhinorrhea, sinusitis, and cough in sensitized individuals. These clinical symptoms are the result of IgE-mediated type I hypersensitivity reactions, which trigger the degranulaton of mast cells and basophils. In contrast, aeroallergens are not common precipitants of urticarial dermatitis, which is driven by a cell-mediated type IV hypersensitivity reaction. In this case report, we describe an Active Duty Air Force member stationed in San Antonio, TX, who presented to the dermatology clinic with a three year history of recalcitrant urticarial dermatitis found to be directly related to exposure to the pollen from the Juniperus ashei tree, also referred to as Mountain Cedar. While laboratory findings confirmed a high level of circulating IgE antibody to Mountain Cedar, the patient had no upper respiratory symptoms consistent with a typical allergic reaction. Further, his skin disease rapidly cleared within 24 hours of leaving southern Texas. Because of the recalcitrant nature of his condition upon returning home, he was considered unfit for further military service. This case not only highlights the growing link between IgE and chronic skin disease, but also the impact aeroallergens can have on the medical readiness and world-wide deployability of Airmen, Sailors, Soldiers, and Marines.
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Vignali, D. A. A., Q. D. Bickle, and M. G. Taylor. "Studies on immunity toSchistosoma mansoni in vivo: whole-body irradiation has no effect on vaccine-induced resistance in mice." Parasitology 96, no. 1 (February 1988): 49–61. http://dx.doi.org/10.1017/s0031182000081658.
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SUMMARYActively immunized mice, whole-body irradiated with 650 or 525 rad., manifested comparable levels of resistance toSchistosoma mansonicompared with unirradiated, immunized mice in spite of a marked reduction in circulating leucocytes (>90%) and platelets (>85%), and despite an abrogation of delayed-type hypersensitivity (DTH) (Type IV) response to schistosomular antigens (as determined by footpad swelling, 24 h after injection of antigen). However, limited histopathological comparison of lung sections from irradiated and unirradiated mice 7 days post-challenge showed that cellular reactions (‘foci’) around parasites were essentially similar in size and cellular composition except that in irradiated mice, eosinophils were poorly represented both in the foci and in lung tissue in general. Neither presumed immune complex-mediated (Type III, Arthus reaction) hypersensitivity (as determined by footpad swelling, 5 h after injection of antigen) nor serum anti-schistosomulum extract antibody levels (as determined by ELISA) were affected. In addition, the pattern of125I-labelled schistosomular surface antigens immunoprecipitated with serum from irradiated and unirradiated mice was essentially similar. These results are consistent with antibody playing an important role in vaccine-induced immunity in mice but suggest that radiosensitive T cell function and radiosensitive cells, such as platelets and polymorphonuclear cells, including eosinophils, may not be essential.
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Alban, Susanne, Roland Kaufmann, Edelgard Lindhoff-Last, Wolf-Henning Boehncke, Ralf J. Ludwig, and Marc Schindewolf. "Molecular weight determines the frequency of delayed type hypersensitivity reactions to heparin and synthetic oligosaccharides." Thrombosis and Haemostasis 94, no. 12 (2005): 1265–69. http://dx.doi.org/10.1160/th05-05-0318.
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SummaryEczematous lesions, resulting from type IV sensitizations are well-known and relatively frequent cutaneous adverse effects of s.c. heparin therapy. If anticoagulation is further required intravenous heparin, heparinoids or lepirudin may be used as a substitute. However, these alternatives are not optimal in terms of practicability and/or safety-profiles. As molecular weight of different heparin preparations has repetitively been implied to determine the frequency of sensitization, we hypothesized, that due to its low molecular weight the pentasaccharide fondaparinux may provide a practicable and safe anticoagulant therapy in patients with delayed type hypersensitivity reactions (DTH) to heparin and other oligosaccharides. To test this concept, patients referred for diagnosis of cutaneous reactions after s.c. anticoagulant treatment underwent a series of in vivo skin allergyand challenge-tests with unfractionated heparin, a series of low molecular weight heparins (nadroparin, dalteparin, tinzaparin, enoxaparin and certoparin), the heparinoid danaparoid and the synthetic pentasaccharide fondaparinux. In total, data from twelve patients was evaluated. In accordance with previously published data, we report a high crossreactivity among heparins and heparinoids. In contrast – and in support of our initial hypothesis – sensitization towards the synthetic pentasaccharide fondaparinux was rarely observed. Plotting the cumulative incidence against the determined molecular weight of the individual anticoagulant preparations, shows that molecular weight generally is a key determinant of sensitization towards heparins and other oligosaccharides (r2=0.842, p=0.009). Hence, fondaparinux may be used as a therapeutic alternative in patients with cutaneous DTH relations towards heparin and other polysaccharides.
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Niempoog, Sunyarn, and Seksan Kukreja. "Neuropathy Caused by Metal Hypersensitivity after Placement of Stainless Steel Plate." Case Reports in Orthopedics 2020 (January 17, 2020): 1–4. http://dx.doi.org/10.1155/2020/9789021.
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Metal hypersensitivity is a rare complication for implants especially with neuropathy involvement. There was not any previous report suggesting metal hypersensitivity manifested in the form of neuropathy or tendinopathy from metal plate implantation. Here, we present a case of a 42-year-old female with chronic ulnar wrist pain and unremarkable physical and radiological findings. Ulna shortening osteotomy with small stainless steel-made DCP and screw fixation was done. On the third day postoperative, the patient developed pain, swelling, ulnar neuropathy, and flexor tendon contracture. Severe adhesion was found around the implant and the ulnar nerve. Minimal skin patch testing reaction and pathological study suggest a cell-mediated delayed type IV hypersensitivity reaction. A titanium-made LCP was later implanted in place of the stainless steel-made DCP. The patient’s clinical status significantly improved after the operation. Metal hypersensitivity in this patient was unprecedented and unique. The severity of the reaction and its location close to the ulnar nerve may predispose to the intensity of the reaction.
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Tan, Terence, Jin W. Tee, and Tiew F. Han. "Cell-mediated allergy to cerebral aneurysm clip causing extensive cerebral edema." Journal of Neurosurgery 121, no. 4 (October 2014): 924–28. http://dx.doi.org/10.3171/2014.6.jns132405.
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The authors report the first case of vasogenic cerebral edema due to a cell-mediated hypersensitivity reaction to a nickel-containing aneurysm clip. The patient initially presented for elective clipping of a right middle cerebral artery aneurysm, and on long-term follow-up she demonstrated relapsing-remitting cerebral edema. Four years post–aneurysm clipping, she underwent an exploratory craniotomy given unsuccessful conservative management of her headaches and imaging evidence of cerebral edema with mass effect. During surgery, gross parenchymal edema and inflammatory nodules were observed. Histopathology was consistent with a cell-mediated (Type IV) hypersensitivity reaction. Concerns regarding nickel allergy are often reported in the cardiac literature. This case highlights the possibility of nickel hypersensitivity when using nickel-containing aneurysm clips, especially in patients with known nickel allergies.
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Tattersall, Ian, and Bobby Y. Reddy. "Fixed Drug Eruption due to Achiote Dye." Case Reports in Dermatology 8, no. 1 (January 28, 2016): 14–18. http://dx.doi.org/10.1159/000443949.
Full textAbstract:
Fixed drug eruption (FDE) is a localized type IV sensitivity reaction to a systemically introduced allergen. It usually occurs as a result of new medication, making identification and avoidance of the trigger medication straightforward; however, in a rare subset of cases no pharmacological source is identified. In such cases, the causative agent is often a food or food additive. In this report we describe a case of a FDE in a 12-year-old girl recently immigrated to the United States from Ecuador who had no medication exposure over the course of her illness. Through an exhaustive patient history and literature review, we were able to hypothesize that her presentation was caused by a dietary change of the natural achiote dye used in the preparation of yellow rice to a locally available commercial dye mix containing tartrazine, or Yellow 5, which has previously been implicated in both systemic hypersensitivity reactions and specifically in FDE. This report adds to the small body of available literature on non-pharmacological fixed hypersensitivity eruptions and illustrates an effective approach to the management of such a presentation when history is not immediately revealing.
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Wen, Wei-Lun, Kun-Bow Tsai, Yi-Huei Lin, Shang-Jyh Hwang, Pi-Jung Hsiao, Shyi-Jang Shin, and Wei-Wen Hung. "Successful management of type IV hypersensitivity reactions to human insulin analogue with injecting mixtures of biphasic insulin aspart and dexamethasone." Journal of the Formosan Medical Association 118, no. 4 (April 2019): 843–48. http://dx.doi.org/10.1016/j.jfma.2019.01.004.
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