DOCSLIB.ORG

Views and finally Assessed for Causality, Preventability, and Immediate Therapeutic Management Dr

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Views and finally Assessed for Causality, Preventability, and Immediate Therapeutic Management Dr Article Adverse Drug Reactions in Patients with CKD Sole`ne M. Laville ,1 Vale´rie Gras-Champel,2 Julien Moragny,2 Marie Metzger,1 Christian Jacquelinet,1,3 Christian Combe ,4,5 Denis Fouque ,6 Maurice Laville,6 Luc Frimat,7,8 Bruce M. Robinson,9 Be´ne´dicte Stengel,1 Ziad A. Massy,1,10 and Sophie Liabeuf ,2,11 on behalf of the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) Study Group* Abstract Background and objectives Little is known about the burden of adverse drug reactions in CKD. We estimated the incidence of overall and serious adverse drug reactions and assessed the probability of causation, preventability, Due to the number of contributing authors, and factors associated with adverse drug reactions in patients seen by nephrologists. the affiliations are listed at the end of Design, setting, participants, & measurements The Chronic Kidney Disease-Renal Epidemiology and Information this article. Network cohort included 3033 outpatients (65% men) with CKD and eGFR,60 ml/min per 1.73 m2,withfollow- up for 2 years. Adverse drug reactions were identified from hospitalization reports, medical records, and Correspondence: participant interviews and finally assessed for causality, preventability, and immediate therapeutic management Dr. Be´ne´dicte Stengel, E´quipe E´pide´miologie by experts in pharmacology. Clinique, Centre for Epidemiology and Results Median (interquartile range) age was 69 (60–76) years old; 55% had eGFR$30 ml/min per 1.73 m2, and 45% Population Health had eGFR,30 ml/min per 1.73 m2. Participants were prescribed a median (range) of eight (five to ten) drugs. Over (CESP) — Inserm U1018, 16 Avenue 2 years, 536 patients had 751 adverse drug reactions, 150 (in 125 participants) classified as serious, for rates of fi fi P. Vaillant Couturier, 14.4 (95% con dence interval, 12.6 to 16.5) and 2.7 (95% con dence interval, 1.7 to 4.3) per 100 person-years, Villejuif Cedex, respectively. Among the serious adverse drug reactions, 32% were considered preventable or potentially France. Email: preventable; 16 caused death, directly or indirectly. Renin-angiotensin system inhibitors (15%), antithrombotic benedicte.stengel@ agents (14%), and diuretics (10%) were the drugs to which the most adverse drug reactions were imputed, but inserm.fr antithrombotic agents caused 34% of serious adverse drug reactions. The drug was discontinued in 71% of cases, at least temporarily. Adjusted hazard ratios for serious adverse drug reaction were significantly higher in patients with eGFR,30 versus $30 ml/min per 1.73 m2 (1.8; 95% confidence interval, 1.3 to 2.6), in those prescribed more than tenversusless than fivemedications(2.4;95%confidence interval,1.1 to 5.2),orinthosewithpoor versus good adherence (1.6; 95% confidence interval, 1.4 to 2.4). Conclusions Adverse drug reactions are common and sometimes serious in patients with CKD. Many serious adverse drug reactions may be preventable. Some specific pharmacologic classes, particularly antithrombotic agents, are at risk of serious adverse drug reactions. Clinical Trial registry name and registration number Chronic Kidney Disease-Renal Epidemiology and In- formation Network (CKD-REIN), NCT03381950 CJASN 15: 1090–1102, 2020. doi: https://doi.org/10.2215/CJN.01030120 Introduction few have examined ADRs in outpatient settings (4). Despite the highly regulated process of drug market- Although clinicians recognize ADRs as a major prob- ing authorization, no medicine is completely safe. lem in patients with CKD, few studies have investi- Adverse drug reactions (ADRs) are relatively com- gated the incidence of and factors associated with mon; they cause 2%–7% of overall hospitalizations ADRs in this population. (1–4). Two French studies (2,5) have reported that Drug-related nephrotoxicity is frequent and well 3.2%–3.6% of hospital admissions are related to ADRs. documented (15). However, the kidney also plays an The concept of ADR has evolved over time, and today, important role in the clearance of many drugs and it includes any harmful and unwanted reaction to a toxic metabolites that can cause ADR due to their drug occurring at doses normally used in humans or accumulation as kidney function declines. Despite resulting from drug misuse or error or from accidental impaired pharmacokinetics and pharmacodynamics or willful overdose (6). Most available studies have (16–18), patients with CKD use multiple medicines focused on ADR-related hospitalizations (with the and are often exposed to some that are inappropri- ADR the cause of admission [2,3,5,7–10], occurring ately prescribed (19). Until now, studies in patients during hospitalization [11,12], or both [1,13,14]); very with CKD have been on the basis of self-reported 1090 Copyright © 2020 by the American Society of Nephrology www.cjasn.org Vol 15 August, 2020 CJASN 15: 1090–1102, August, 2020 Adverse Drug Reactions in CKD, Laville et al. 1091 ADRs (20), have concerned specific drugs during clinical insurance, but none of these differences affect the recording trials (21,22), or have been restricted to ADRs during and processing of prescriptions. Accordingly, drug pre- hospitalization (23) or to specific types of ADRs (24). None scriptions were continuously recorded from 3 months of the studies reported therapeutic management after the preceding inclusion through the end of follow-up. We ADR. No comprehensive evaluation exists of the in- used the international Anatomic Therapeutic and Chemical cidence, probability of causation, and preventability of thesaurus (28) to code treatments and recorded their start ADRs in both inpatients and outpatients belonging to and discontinuation dates (with causes, if any). Kidney this population. failure events, defined as dialysis start or preemptive The primary objective of this study was to estimate the transplantation, and deaths were reported by the partici- incidence rates of overall and serious ADRs according to pants or their families, or they were identified from medical eGFR in patients with moderate or advanced CKD treated records or record linkage with the national kidney fail- by a nephrologist. Secondary objectives aimed at assessing ure registry (29). their causation, preventability, associated factors, and immediate therapeutic management. Identification and Validation of Adverse Drug Reactions An ADR is defined as “an appreciably harmful or Materials and Methods unpleasant reaction, resulting from an intervention related Study Design and Participants to the use of a medicinal product, which predicts hazard fi The Chronic Kidney Disease-Renal Epidemiology and from future administration and warrants prevention or speci c Information Network (CKD-REIN) is a prospective cohort treatment, or alteration of the dosage regimen, or withdrawal ” study conducted in 40 nationally representative nephrol- of the product (6). An ADR is considered serious when the ogy outpatient facilities in France. Eligible patients were at patient outcome is death (or a life-threatening situation), least 18 years of age, had a confirmed diagnosis of hospitalization (initial or prolonged), disability or permanent moderate or advanced CKD, had an eGFR,60 ml/min damage, or another important medical event (30). per 1.73 m2, were not on dialysis, and had not been We collected ADRs over a 2-year follow-up via an fi transplanted. From July 2013 to March 2016, CKD-REIN electronic form designed speci cally to include information included 3033 patients. Details of the study protocol and critical for this study. We used several sources to identify flow chart have been published elsewhere (25). The in- ADRs: (1) medical records (examined by CRAs), (2) stitutional review board of the French National Institute of participant interviews by CRAs, and (3) hospital reports fi Health and Medical Research (reference: IRB00003888) (Figure 1). Hospitalizations were identi ed from (1)elec- approved the protocol, and the study was registered at tronic medical records, (2) nephrology records, and (3) ClinicalTrials.gov (NCT03381950). participant interviews. For each hospitalization, we ob- tained a report to confirm the period and the cause. Causes of hospitalization were coded by a physician according to Information the tenth revision of the International Classification of Data were collected at baseline and then annually by Diseases. Every drug prescribed to the patient at the time of trained clinical research associates (CRAs) from participant each ADR was recorded. Each identified ADR was re- interviews and medical records from the nephrology viewed by two pharmacists (S.L. and S.M.L.) who evalu- centers that included them. All of them contain patient ated the potential causation of reported drug-related ADRs histories, hospitalizations reports, imaging, and laboratory and coded the types of effect according to the medical data from every ward of the hospital/clinic, but they are dictionary for regulatory activities (MedDRA Dictionary), not standardized and may differ between these centers. the severity of the ADR (nonserious or serious), the drug Data collected included sociodemographic characteristics suspected of responsibility for the ADR, its dosage, and and a history of hypertension, diabetes, cardiovascular immediate medication management: discontinuation of the disease, dyslipidemia, or AKI, as defined previously (25). product, dose adaptation, or no change. If the ADR was Medication adherence was assessed with the Girerd score considered serious, a larger committee of expert pharma- (26), which was calculated by asking
Load more

Recommended publications
  • Drug Allergy: Diagnosis and Management of Drug Allergy in Adults and Children
    NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE 1 Guideline title Drug allergy: diagnosis and management of drug allergy in adults and children 1.1 Short title Drug allergy 2 The remit The Department of Health has asked NICE: ‘To produce a clinical guideline on Drug allergy: diagnosis and management of drug allergy in adults and children 3 Clinical need for the guideline 3.1 Epidemiology a) Diagnosing a drug allergy is challenging, with considerable variation in service provision, practice and referral pattern. This can lead to under-diagnosis, misdiagnosis and self-diagnosis. b) All drugs have the potential to cause side effects, also known as adverse drug reactions, but not all of these are allergic in nature; other reactions are caused by drug intolerance, idiosyncratic reactions and pseudo-allergic reactions. c) The British Society for Allergy and Clinical Immunology (BSACI) defines drug allergy as an adverse drug reaction with an established immunological mechanism. However, the mechanism at presentation may not be apparent from the clinical history, and therefore, whether a drug reaction is allergic or non-allergic cannot always be established without investigation. Drug allergy guideline – Draft scope for consultation 3–31 October 2012 Page 1 of 8 d) Drug allergy can be further defined as an immune-mediated hypersensitivity reaction to a medicinal product and may be divided into immunoglobulin E (IgE)-mediated (immediate onset) and non- IgE-mediated (delayed onset, usually involving T cells) reactions. e) Adverse drug
    [Show full text]
  • Hypersensitivity to Nonsteroidal Anti-Inflammatory Drugs: from Pathogenesis to Clinical Practice
    ARTIGO DE REVISÃO Hypersensitivity to nonsteroidal anti-inflammatory drugs: From pathogenesis to clinical practice Hipersensibilidade a anti-inflamatórios não esteroides: Da patogénese à prática clínica Data de receção / Received in: 28/10/2017 Data de aceitação / Accepted for publication in: 17/11/2017 Rev Port Imunoalergologia 2018; 26 (3): 207-220 Inês Mota, Ângela Gaspar, Mário Morais-Almeida Imunoallergy Department, CUF Descobertas Hospital, Lisbon ABSTRACT Nonsteroidal anti - inflammatory drugs (NSAIDs) are one of the leading causes of hypersensitivity reactions, which affect a considerable percentage of the general population. These drugs can induce a wide spectrum of reactions with distinct timing, organ involvement and severity, including either immunological or nonimmunological mechanisms. A proper diagnosis can be particularly challenging since most reactions result from the pharmacological mechanism of the drug and might be dose - dependent. The clinical classification of NSAIDs - induced reactions has changed over time. Accurate diagnosis depends on strict clinical history and proper understanding of underlying mechanism. Skin testing and in vitro testing have limited usefulness. Drug chal- lenge tests with the culprit or alternative drugs are the gold standard for the diagnosis, and provide information about drug avoidance and safe therapeutic options. In selected cases drug desensitization might be a therapeutic option. In this review, we will attempt to highlight the main aspects to be taken into account for a proper management of patients with NSAIDs hyper- sensitivity. Key - words: Acetylsalicylate acid, alternative drugs, desensitization, diagnosis, hypersensitivity, nonsteroidal anti - inflammatory drugs. 207 REVISTA PORTUGUESA DE IMUNOALERGOLOGIA Inês Mota, Ângela Gaspar, Mário Morais-Almeida RESUMO Os anti - inflamatórios não esteroides (AINEs) são uma das principais causas de reações de hipersensibilidade, afetando uma percentagem considerável da população em geral.
    [Show full text]
  • Pilot Study to Assess Outcomes of a Drug Allergy Clarification Service on a General Medicine Floor at a Local Community Hospital Crystal M
    Original Research PRACTICE-BASED RESEARCH Pilot Study to Assess Outcomes of a Drug Allergy Clarification Service on a General Medicine Floor at a Local Community Hospital Crystal M. Deas, PharmD, BCPS1; C. Whitney White, PharmD, BCPS2 1Samford University, McWhorter School of Pharmacy, Clinical Pharmacist, Cooper Green Mercy Health Services, Birmingham, AL 2University of Mississippi School of Pharmacy, University of Mississippi Medical Center, Jackson, MS Abstract Purpose: Drug allergy documentation in the patient medical record varies in level of detail, and drug intolerances are often inappropriately documented as an allergy in the medical record. A pilot study was conducted to determine the impact of a pharmacy- led drug allergy clarification service. Methods: The pilot quality improvement service was implemented in Fall 2016. General medicine patients were identified through daily census reporting and the electronic medical record (EMR) was reviewed within 72 hours of admission for documented drug allergies and/or intolerances. Patients were interviewed by a clinical pharmacist or a fourth year pharmacy student to determine a complete drug allergy and intolerance history. Results: A total of 55 patients were interviewed and received the pilot service. A drug allergy/intolerance was documented in EMR for 54.5% (n=30) of patients interviewed. Of those 30 patients, 96.6% (n=29) were noted to have at least one discrepancy between EMR documentation and patient interview. The primary discrepancy noted was drug allergies or intolerances documented in the EMR without a description of the reaction. Conclusion: A pharmacy-led drug allergy clarification service was effective in identifying and clarifying EMR documentation of patients’ drug allergies and intolerances.
    [Show full text]
  • Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs
    Specific Drugs Practical Guidance for the Evaluation and Management of Drug Hypersensitivity: Specific Drugs Chief Editors: Ana Dioun Broyles, MD, Aleena Banerji, MD, and Mariana Castells, MD, PhD Ana Dioun Broyles, MDa, Aleena Banerji, MDb, Sara Barmettler, MDc, Catherine M. Biggs, MDd, Kimberly Blumenthal, MDe, Patrick J. Brennan, MD, PhDf, Rebecca G. Breslow, MDg, Knut Brockow, MDh, Kathleen M. Buchheit, MDi, Katherine N. Cahill, MDj, Josefina Cernadas, MD, iPhDk, Anca Mirela Chiriac, MDl, Elena Crestani, MD, MSm, Pascal Demoly, MD, PhDn, Pascale Dewachter, MD, PhDo, Meredith Dilley, MDp, Jocelyn R. Farmer, MD, PhDq, Dinah Foer, MDr, Ari J. Fried, MDs, Sarah L. Garon, MDt, Matthew P. Giannetti, MDu, David L. Hepner, MD, MPHv, David I. Hong, MDw, Joyce T. Hsu, MDx, Parul H. Kothari, MDy, Timothy Kyin, MDz, Timothy Lax, MDaa, Min Jung Lee, MDbb, Kathleen Lee-Sarwar, MD, MScc, Anne Liu, MDdd, Stephanie Logsdon, MDee, Margee Louisias, MD, MPHff, Andrew MacGinnitie, MD, PhDgg, Michelle Maciag, MDhh, Samantha Minnicozzi, MDii, Allison E. Norton, MDjj, Iris M. Otani, MDkk, Miguel Park, MDll, Sarita Patil, MDmm, Elizabeth J. Phillips, MDnn, Matthieu Picard, MDoo, Craig D. Platt, MD, PhDpp, Rima Rachid, MDqq, Tito Rodriguez, MDrr, Antonino Romano, MDss, Cosby A. Stone, Jr., MD, MPHtt, Maria Jose Torres, MD, PhDuu, Miriam Verdú,MDvv, Alberta L. Wang, MDww, Paige Wickner, MDxx, Anna R. Wolfson, MDyy, Johnson T. Wong, MDzz, Christina Yee, MD, PhDaaa, Joseph Zhou, MD, PhDbbb, and Mariana Castells, MD, PhDccc Boston, Mass; Vancouver and Montreal,
    [Show full text]
  • A5343 a Trial of the Safety, Tolerability, and Pharmacokinetics of Bedaquiline and Delamanid, Alone and in Combination, Among Pa
    A5343 A Trial of the Safety, Tolerability, and Pharmacokinetics of Bedaquiline and Delamanid, Alone and in Combination, among Participants Taking Multidrug Treatment for Drug-Resistant Pulmonary Tuberculosis A Limited-Center Trial of the AIDS Clinical Trials Group (ACTG) Sponsored by: National Institute of Allergy and Infectious Diseases Industry Support Provided by: Janssen Pharmaceuticals, Inc. Otsuka Pharmaceutical Company, Ltd. ViiV Healthcare, Ltd. IND# 127,382 The ACTG Tuberculosis Transformative Science Group Gavin Churchyard, MBBCh, MMED, FCP, PhD, Chair Protocol Co-Chairs: Kelly Dooley, MD, PhD Gary Maartens, MBChB, MMed Protocol Vice Chair: Francesca Conradie, MD, DTM&H DAIDS Clinical Representatives: Richard Hafner, MD Roxana Rustomjee MbChB, MMed, FCPhM, FRCP, PhD Clinical Trials Specialists: Laura E. Moran, MPH Chanelle Houston, BS FINAL Version 4.0 June 26, 2018 A5343 FINAL Version 4.0 06/26/18 A Trial of the Safety, Tolerability, and Pharmacokinetics of Bedaquiline and Delamanid, Alone and in Combination, among Participants Taking Multidrug Treatment for Drug-Resistant Pulmonary Tuberculosis SIGNATURE PAGE I will conduct the study in accordance with the provisions of this protocol and all applicable protocol-related documents. I agree to conduct this study in compliance with United States (US) Health and Human Service regulations (45 CFR 46); applicable U.S. Food and Drug Administration regulations; standards of the International Conference on Harmonization Guideline for Good Clinical Practice (E6); Institutional Review
    [Show full text]
  • ASCIA Consensus Cephalosporin Allergy
    Drug (Medication) Allergy Terms This document has been developed by the ASCIA Drug Allergy Committee to assist clinical immunology/allergy specialists and other health professionals who manage drug allergy. It is based on expert consensus and references listed on page 9. ASCIA Drug Allergy Committee members are listed on the ASCIA website www.allergy.org.au/members/committees#dac SUMMARY OF ADVERSE DRUG REACTIONS AND DRUG ALLERGY 1 ASCIA Information for Health Professionals - Drug Allergy Terms TERMS ASSOCIATED WITH DRUG ALLERGY • Acute generalised exanthematous pustulosis (AGEP), also known as Acute generalised pustular drug eruption and toxic pustuloderma, is a rare severe exanthematous cutaneous adverse skin reaction (SCAR), that is mostly related to pustulosis (AGEP) medication administration. • AGEP appears on average five days after a medication is started. • Adverse drug reactions (ADRs) is a general term that includes all unintended effects of a drug except for therapeutic failures, intentional overdose, abuse of the drug or errors in administration. ADRs can be Adverse drug classified into two types: reactions (ADRs) - Type A reactions are predictable reactions and are based on known pharmacological properties of the drug. - Type B reactions are unpredictable and include drug allergy, drug intolerance and idiosyncratic reactions to drugs. • Anaphylaxis is a severe and immediate Immunoglobulin E (IgE) mediated allergic reaction. • Anaphylaxis can affect breathing and/or the heart and blood pressure. • Anaphylaxis is potentially life threatening and requires urgent medical attention. Anaphylaxis • Whist anaphylaxis is more likely when medication is given by intravenous (IV) or intramuscular injection (IMI), anaphylaxis to oral medications can also occur. • The most common causes of anaphylaxis are allergies to drugs (medications), foods and insect bites or stings.
    [Show full text]
  • Adverse Drug Reaction and Toxicity Caused by Commonly Used Antimicrobials in Canine Practice
    Veterinary World, EISSN: 2231-0916 REVIEW ARTICLE Available at www.veterinaryworld.org/Vol.7/May-2014/6.pdf Open Access Adverse drug reaction and toxicity caused by commonly used antimicrobials in canine practice 122234 K. Arunvikram , Ipsita Mohanty , K. K. Sardar , S. Palai , G. Sahoo and R. C. Patra 1. Division of Pharmacology and Toxicology, Indian Veterinary Research Institute, Izatnagar -243122, Uttar Pradesh, India: 2. Department of Pharmacology and Toxicology, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India;3. Department of Biochemistry, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India; 4. Department of Clinical Medicine, Veterinary College, Orissa University of Agricultural and Technology, Bhubaneswar - 751 003, Odisha, India Corresponding author: Ipsita Mohanty, email: [email protected] Received:20-03-2014, Revised: 05-04-2014, Accepted: 08-04-2014, Published online: 08-05-2014 doi: 10.14202/vetworld.2014.299-305 How to cite this article: Arunvikram K, Mohanty I, Sardar KK, Palai S, Sahoo G and Patra RC (2014) Adverse drug reaction and toxicity caused by commonly used antimicrobials in canine practice,Veterinary World 7(5): 299-305. Abstract An adverse drug reaction (ADR) is a serious concern for practicing veterinarians and other health professionals, and refers to an unintended, undesired and unexpected response to a drug that negatively affects the patient's health. It may be iatrogenic or genetically induced, and may result in death of the affected animal. The ADRs are often complicated and unexpected due to myriad clinical symptoms and multiple mechanisms of drug-host interaction. Toxicity due to commonly used drugs is not uncommon when they are used injudiciously or for a prolonged period.
    [Show full text]
  • Genetic Variability of Drug-Metabolizing Enzymes: the Dual Impact on Psychiatric Therapy and Regulation of Brain Function
    Molecular Psychiatry (2013) 18, 273 -- 287 & 2013 Macmillan Publishers Limited All rights reserved 1359-4184/13 www.nature.com/mp EXPERT REVIEW Genetic variability of drug-metabolizing enzymes: the dual impact on psychiatric therapy and regulation of brain function JC Stingl1,4, J Brockmo¨ ller2 and R Viviani3 Polymorphic drug-metabolizing enzymes (DMEs) are responsible for the metabolism of the majority of psychotropic drugs. By explaining a large portion of variability in individual drug metabolism, pharmacogenetics offers a diagnostic tool in the burgeoning era of personalized medicine. This review updates existing evidence on the influence of pharmacogenetic variants on drug exposure and discusses the rationale for genetic testing in the clinical context. Dose adjustments based on pharmacogenetic knowledge are the first step to translate pharmacogenetics into clinical practice. However, also clinical factors, such as the consequences on toxicity and therapeutic failure, must be considered to provide clinical recommendations and assess the cost-effectiveness of pharmacogenetic treatment strategies. DME polymorphisms are relevant not only for clinical pharmacology and practice but also for research in psychiatry and neuroscience. Several DMEs, above all the cytochrome P (CYP) enzymes, are expressed in the brain, where they may contribute to the local biochemical homeostasis. Of particular interest is the possibility of DMEs playing a physiological role through their action on endogenous substrates, which may underlie the reported associations between genetic polymorphisms and cognitive function, personality and vulnerability to mental disorders. Neuroimaging studies have recently presented evidence of an effect of the CYP2D6 polymorphism on basic brain function. This review summarizes evidence on the effect of DME polymorphisms on brain function that adds to the well- known effects of DME polymorphisms on pharmacokinetics in explaining the range of phenotypes that are relevant to psychiatric practice.
    [Show full text]
  • Practical Guidelines for Diagnosing Hypersensitivity Reactions to Nonsteroidal Anti-Inflammatory Drugs
    GUIDELINES Practical Guidelines for Diagnosing Hypersensitivity Reactions to Nonsteroidal Anti-inflammatory Drugs N Ortega,1 I Doña,2 E Moreno,3 MT Audicana,4 MJ Barasona,5 MP Berges-Gimeno,6 N Blanca-Lopez,7 T Lobera,8 A Padial,9 A Rosado,10 MJ Torres2 1Allergy Service, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain 2Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain 3Allergy Service, Hospital Universitario de Salamanca, Salamanca, Spain 4Allergy Service, Santiago Apóstol Hospital, Vitoria-Gasteiz, Spain 5Allergy Service, Reina Sofía University Hospital, Córdoba, Spain 6Allergy Division, Ramon y Cajal University Hospital, Madrid, Spain 7Allergy Service, Infanta Leonor Hospital, Madrid, Spain 8Allergy Service, Centro de Alta Resolución San Millán, Logroño, Spain 9Allergy Service, La Paz Hospital, Madrid, Spain 10Allergy Service, Alcorcón Hospital, Madrid, Spain Abstract Nonsteroidal anti-inflammatory drugs (NSAIDs) are the drugs most frequently involved in hypersensitivity reactions. These reactions include various clinical entities with different mechanisms leading to the release of inflammatory mediators. Characterization of patients based on clinical manifestations and suspected underlying mechanisms is critical for implementation of adequate diagnostic procedures and patient management. Our objectives were to prepare a systematic review of available scientific evidence and to provide general guidelines for the diagnosis and management of patients with hypersensitivity reactions to NSAIDs. We also propose a practical algorithm for the diagnosis of specific types of hypersensitivity to NSAIDs and provide recommendations for the management of hypersensitive patients. Key words: Nonsteroidal anti-inflammatory drugs (NSAIDs). Hypersensitivity. Intolerance. Idiosyncrasy. Acetylsalicylic acid. Algorithm. Diagnosis. Resumen Los antiinflamatorios no esteroideos (AINE) es el grupo farmacológico que más frecuentemente ha sido relacionado con las reacciones de hipersensibilidad.
    [Show full text]
  • Biomarkers in Drug Hypersensitivity
    BIOMARKERS IN DRUG HYPERSENSITIVITY EDITED BY : José A. G. Agúndez, Silvia Selinski, Emanuela Corsini, Klaus Golka and Elena García-Martín PUBLISHED IN : Frontiers in Pharmacology Frontiers Copyright Statement About Frontiers © Copyright 2007-2017 Frontiers Media SA. All rights reserved. Frontiers is more than just an open-access publisher of scholarly articles: it is a pioneering All content included on this site, approach to the world of academia, radically improving the way scholarly research such as text, graphics, logos, button icons, images, video/audio clips, is managed. The grand vision of Frontiers is a world where all people have an equal downloads, data compilations and software, is the property of or is opportunity to seek, share and generate knowledge. Frontiers provides immediate and licensed to Frontiers Media SA permanent online open access to all its publications, but this alone is not enough to (“Frontiers”) or its licensees and/or subcontractors. The copyright in the realize our grand goals. text of individual articles is the property of their respective authors, subject to a license granted to Frontiers. Frontiers Journal Series The compilation of articles constituting The Frontiers Journal Series is a multi-tier and interdisciplinary set of open-access, online this e-book, wherever published, as well as the compilation of all other journals, promising a paradigm shift from the current review, selection and dissemination content on this site, is the exclusive processes in academic publishing. All Frontiers journals are driven by researchers for property of Frontiers. For the conditions for downloading and researchers; therefore, they constitute a service to the scholarly community.
    [Show full text]
  • The Multiple Faces of Nonsteroidal Antiinflammatory Drug Hypersensitivity M
    M. Sánchez-Borges, et al. Original Article The multiple faces of nonsteroidal antiinflammatory drug hypersensitivity M. Sánchez-Borges1,2, A. Capriles-Hulett1,3, F. Caballero-Fonseca1,3 1 Centro Médico-Docente La Trinidad, 2 Clínica El Avila, 3 Centro Médico de Caracas, Caracas, Venezuela Summary. Based on the clinical picture and triggering drugs, allergic and pseudoallergic adverse reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) can be classified in four patterns : respiratory, cutaneous, mixed and systemic. This categorization is useful for the purpose of describing patient populations included in studies about NSAID adverse reactions as well as for the routine management of the patient in the clinical setting. Key words: Non steroidal anti-inflammatory drugs. Urticaria. Angioedema. Asthma. Cysteinil-leukotrienes. Cyclooxygenases. Introduction and pseudoallergic reactions to drugs that inhibit cyclooxygenase enzymes [2]. In this paper we would like Nonsteroidal anti-inflammatory drugs (NSAIDs) are to discuss in detail the clinical features of these reactions recognized among the most frequently used therapeutic in an attempt to give clinicians further insights for the agents all over the world, and average consumption has better management of patients suffering from them. For been estimated as high as 80 tablets per person per year the purpose of this article, four clinical patterns will be [1]. Due to the magnitude of exposure, it is not surprising analyzed: 1) Respiratory 2) Cutaneous 3) Mixed 4) Sys- that NSAIDs are one
    [Show full text]
  • Diagnosis and Management of Drug Allergy in Adults, Children and Young People
    DRAFT FOR CONSULTATION Drug allergy: diagnosis and management of drug allergy in adults, children and young people NICE guideline Draft for consultation, April 2014 If you wish to comment on this version of the guideline, please be aware that all the supporting information and evidence is contained in the full version. Drug Allergy: NICE guideline DRAFT (April 2014) Page 1 of 29 DRAFT FOR CONSULTATION Contents Introduction ...................................................................................................... 3 Drug recommendations ................................................................................ 5 Patient-centred care ......................................................................................... 6 Strength of recommendations .......................................................................... 7 Key priorities for implementation ...................................................................... 9 1 Recommendations .................................................................................. 13 1.1 Assessment ...................................................................................... 13 1.2 Documenting and sharing information with other healthcare professionals .............................................................................................. 15 1.3 Providing information and support to patients ................................... 17 1.4 Non-specialist management and referral to specialist services ........ 18 2 Research recommendations ..................................................................
    [Show full text]