Gavin Wong

Clinical and immunogenetic correlates of abacavir hypersensitivity

A patch test (PT) may be useful in defining true abacavir hypersensitivity syndrome (AHS). Seven previously PT-positive patients remote from the original AHS were shown to have robust 24 h responses, supporting PT durability. HLA-B*5701 was present in all seven PT-positive versus one of 11 controls tolerating abacavir (P < 0.001). Five of seven PT (71%) versus one of 11 controls (9%) (P = 0.005) showed significant abacavir-specific CD8 proliferation, suggesting a direct role for HLA-B*5701-restricted CD8 cells in the pathophysiology of AHS.

Hydrochlorothiazide-Induced Noncardiogenic Pulmonary Edema: An Underrecognized Yet Serious Adverse Drug Reaction

Noncardiogenic pulmonary edema is a rare but potentially life‐threatening complication of hydrochlorothiazide therapy. We describe three patients who developed this serious adverse reaction. A 64‐year‐old woman developed dypsnea and hypotension within 60 minutes of taking a single dose of hydrochlorothiazide 25 mg. She was admitted to the critical care unit with acute respiratory failure and subsequent multiple‐organ dysfunction. The second patient was a 56‐year‐old woman who experienced sudden onset of shortness of breath that developed 10 minutes after taking a single dose of hydrochlorothiazide 25 mg. The third was a 59‐year‐old woman who developed sudden onset of shortness of breath, nausea, vomiting, and diarrhea after her first dose of hydrochlorothiazide‐triamterene. All three women had a history of a similar, albeit minor, reaction to a thiazide diuretic. Review of the literature identified 36 additional cases of noncardiogenic pulmonary edema after thiazide use. The patients developed symptoms 10–150 minutes after ingestion of hydrochlorothiazide or another thiazide. Symptoms can occur on first exposure to the drug or in patients taking the drug intermittently. Of interest, 90% of documented cases occurred in women. With the increasing use of thiazide diuretics in the treatment of hypertension, clinicians need to be aware of the possible association of these drugs with the development of noncardiogenic pulmonary edema.

14 Dermatological drugs, topical agents, and cosmetics

Publisher Summary This chapter examines the dermatological drugs, topical agents, and cosmetics. Botulinum toxin A is used for the treatment of facial rhytides by producing weakness or paralysis of the associated muscles, and in the treatment of hyperhidrosis. Transient adverse effects, such as temporary bruising, discomfort, incomplete muscle paralysis, or headache, can occur. Focal weakness was the only adverse event that occurred significantly more often with botulinum toxin A than control. It is found that although p –phenylenediamine (PPD) and toluene-2,5-diamine are the most frequently reported hair dye allergens, allergic contact dermatitis from direct dyes for hair coloration is unusual. Two patients with a history of PPD allergic contact dermatitis had positive patch tests to HC Yellow 7, 4 amino-3-nitrophenol and HC Red B54 in hair dyes. The main adverse effects associated with finasteride are loss of libido, erectile dysfunction, and reduced ejaculate volume. In clinical trials, 4.4% of patients treated with finasteride and 2.2% of patients taking placebo experienced sexual adverse effects. Systemic and topical psoralens plus ultraviolet A irradiation (PUVA therapy) are well-established treatments for vitiligo. Adverse effects of PUVA therapy include nonmelanoma skin cancer and PUVA-induced lentigines. It is found that lentigines are common among PUVA-treated patients with psoriasis, but rare in patients with vitiligo.