Heike Röckmann

The High Impact of Penicillin Allergy Registration in Hospitalized Patients.

BACKGROUND Suspected penicillin allergy (Pen-A) is often not verified or excluded by diagnostic testing. OBJECTIVE To assess the prevalence and impact of Pen-A registration in a Dutch University Medical Center. METHODS In a prospective matched cohort study, all admitted patients (July 2013-July 2014) who underwent a pharmacotherapeutic interview were selected. Patients with a registered Pen-A were matched on age, sex, and department of admission with up to 3 patients without a registered Pen-A. Relative risks (RRs) of receiving a reserve antibiotic, death during hospitalization, and rehospitalization were compared in the 2 cohorts. The number and type of antibiotics prescribed during admission and duration of hospitalization were compared. RESULTS Of 17,959 patients, 1010 (5.6%) patients (66.7% women; median age, 55 years) had a Pen-A registration. These patients had a higher risk of receiving reserve antibiotics (RR, 1.38; 95% CI, 1.22-1.56) and of being rehospitalized within 12 weeks (RR, 1.28; 95% CI, 1.10-1.49). A significantly larger proportion of Pen-A registered patients received reserve antibiotics such as tetracyclines (1.8% vs 0.8%), macrolides/lincosamides/streptogramins (12.5% vs 4.9%), and quinolones (7.9% vs 4.3%) or received 2 or more types of antibiotics during hospitalization (21.7% vs 16.9%). CONCLUSIONS Prevalence of Pen-A registration in hospitalized patients is high, has high impact on antibiotic prescribing, and is associated with a higher risk of readmission. Verification of the Pen-A in hospitalized patients might restrict the use of reserve antibiotics and improve patient outcome.

Food allergen sensitization pattern in adults in relation to severity of atopic dermatitis

BackgroundLimited data are available on the frequency of IgE mediated food sensitization and food allergy (FA) in adults with atopic dermatitis (AD).ObjectiveWe investigated the pattern of food sensitization in adults with AD in relation to AD severity using multiplexed allergen microarray.Methods211 adult patients referred between January 2010-July 2011 for evaluation of AD were unselectively included. Severity of AD was determined by therapy intensity, SASSAD-skin-score and sTARC levels. Allergen specific sIgE levels were measured by ImmunoCAP ISAC® microarray. FA was defined as convincing history taken by physician and sensitization to the corresponding allergen.ResultsSensitization to food was found in 74.4% of the AD patients, 54% had a positive history of FA and 20.4% asymptomatic sensitization. There was no association between severity of AD and frequency of food sensitization or history of FA.Sensitization to PR-10 related food allergens occurred most frequently (63.5%) and was independent from AD severity. Correspondingly, pollen-food syndrome accounted for most of the FA, being also independent from AD severity. Of all plant food allergens only sensitization to nAra h 1 was significantly more frequent in patients with severe AD. In the total group 75 (35.5%) patients with AD showed sensitization to any animal food allergen. The percentage was significantly higher in patients with severe AD (51.4%) compared to patients with mild/moderate AD (27.7%). Sensitization to cow’s milk allergens, in particular to nBos d lactoferrin, was more frequent in severe AD patients.ConclusionAD was frequently associated with food sensitization. The percentage of sensitization to animal food allergens was significantly higher in severe AD patients.

Tolerance to alternative cyclooxygenase-2 inhibitors in nonsteroidal anti-inflammatory drug hypersensitive patients

BackgroundNon-steroidal anti-inflammatory drugs (NSAIDs) frequently cause adverse drug reactions. Many studies have shown that drugs which selectively inhibit the cyclooxygenase-2 enzyme (COX-2) are safe alternatives in the majority of patients. However, hypersensitivity reactions to COX-2 inhibitors have been published. Hardly any data are available regarding the safety of alternatives in case of COX-2 inhibitor hypersensitivity. We aimed to investigate the tolerance to COX-2 inhibitors in patients with non-selective NSAID hypersensitivity. Furthermore, in COX-2 hypersensitive patients tolerance of a second COX-2 inhibitor was investigated.MethodsWe retrospectively analyzed 91 patients with proven non-selective NSAID hypersensitivity that underwent oral challenges with a COX-2 inhibitor. Patients with intolerance to the first challenged COX-2 inhibitor received a second challenge with a different COX-2 inhibitor.Results19 out of 91 (21%) patients had a positive reaction to the first oral challenge with a COX-2 inhibitor. 14 of them underwent a second challenge with a different COX-2 inhibitor and 12 (86%) did not react.ConclusionsA relatively high percentage (21%) of the non-selective NSAID hypersensitive patients did not tolerate a COX-2 inhibitor and oral challenge is advised prior to prescription of a COX-2 inhibitor. For the majority of patients reacting to a COX-2 inhibitor an alternative can be found.

Drug rash with eosinophilia and systemic symptoms caused by the dietary supplement diindolylmethane

Drug rash with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction that is potentially life threatening with a mortality rate up to 10%. It is characterized by a variable combination of severe skin eruption, fever, lymphocyte activation (enlarged lymph nodes and atypical lymphocytes), eosinophilia, and internal organ involvement of which the liver is the most common affected organ. Compared with other cutaneous drug reactions, DRESS is characterized by a late onset, usually 2-8 weeks after the initiation of the drug (mainly antiepileptic drugs, allopurinol, and antibiotics) therapy, and a longer duration of symptoms despite discontinuation of the culprit drug. For the first time, we report a case of DRESS that is caused by a dietary supplement. Our patient reacted to diindolylmethane (DIM), which is derived from cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, and Brussels sprouts. It is also an investigational drug being used in treating conditions related to human papilloma virus infection, such as cervical intraepithelial neoplasia and recurrent respiratory papillomatosis, and it is considered a potential chemopreventive agent. The current frequency of DIM consumption is unknown. Previous studies on the safety of DIM showed no severe adverse reactions.

Food sensitisation patterns measured by ISAC multiplex assay in the Netherlands

Results Of 943 ISAC tests, 852 showed sensitization to at least one component and were included for further analysis. Mean age was 33,4 years. The majority of patients in our population was poly-sensitized, with 66% recognizing more than ten components. The most recognized component was Bet v 1 (70%). The top 10 food allergens were: apple (Mal d 1; 65%), peach (Pru p 1; 63%), hazelnut (Cor a 1.0401; 63%), peanut (Ara h 8; 56%, Ara h 6; 23%, Ara h 2; 15%), soy (Gly m 4; 39%), celery (Api g 1; 25%), kiwi (Act d 8; 20%) and walnut (Jug r 2; 15%). 84% showed sensitization to one or more food allergens. Within this group, 84% recognized at least one PR-10 component, followed by storage proteins (35%) and non-specific lipid transfer proteins (nsLTP; 12%). The prevalence of sensitization to cross-reactive carbohydrate determinants (CCD) within the entire population was 9%. Sensitization to at least one food components of animal origin (cow’s milk/egg) was seen in 19% of all cases, with Bos d 8 recognized most frequently (8.1%). The ISAC seems to support clinical suspicion of food allergy in most cases, although sensitization together with a negative patient history is common.