Inês Cristina Camelo Nunes

Drug hypersensitivity in students from São Paulo, Brazil

BACKGROUND: Drug hypersensitivity is responsible for substantial mortality and morbidity, and increased health costs. However, epidemiological data on drug hypersensitivity in general or specific populations are scarce. METHODS: We performed a cross-sectional survey of 1015 university students, using a self-reported questionnaire. RESULTS: The prevalence of self-reported drug hypersensitivity was 12,11% (123/1015). The most frequently implicated drugs were non-steroidal anti-inflammatory drugs (45,9%) and beta-lactam and sulfonamide antibiotics (25,40%). The majority of the patients reported dermatological manifestations (99), followed by respiratory (40), digestive (23) and other (19). Forty-five patients had an immediate type reaction, and 76,72% (89) had the drug by oral route. CONCLUSION: The results showed that drug hypersensitivity is highly prevalent in university students, and that non-steroidal anti-inflammatory drug and antibiotics (beta-lactams and sulfonamide) are the most frequently concerned drugs.

Chronic urticaria: the first visit in a specialized unit

Results Among the 50 CU patients, 70% were female. The mean age at the consultation was 33 years, but the mean age of symptoms onset was 15.3 years. Fifty one percent referred only urticaria, 44% referred urticaria associated with angioedema and 5% presented isolated angioedema. Besides itching, 6 patients complained of burning (12%) and 2 of pain (4%). Frequency of wheals was daily in 33%, weekly in 36% and monthly in 31%. At first visit, Urticaria Activity Score was verified in 24 patients, resulting > 3 in half of them. The most associated atopic disease was rhinitis (45%). Many patients mentioned triggers as medicines (33%), food (23%), stress (17%), viral infection (8%) and physical agents (16%). Only 6% had thyroidopathy. As previous treatment a significant amount of patients received sedating antihistamines (AH) (36%) or oral corticosteroids (24%), with partial improvement in 65% and complete improvement in 29%. Dermographism was positive in 91% of the patients tested (20/22). One of them was diagnosed with cholinergic urticaria and another one with delayed pressure urticaria.

[Asthma in children: classification and treatment]

OBJECTIVES: To review concepts, classification based on severity, and long term treatment for children with asthma. METHODS: To identify precipitating factors of acute asthma attacks and classify the disease in order to establish long term treatment. RESULTS: Different plans of management according to its classification: mild, moderate and severe asthma. Antiinflammatory therapy is reserved to moderate and severe asthma. CONCLUSIONS: The identification and control of the etiologic and precipitating factors are important tasks in the management of asthma. The inhalatory route is the most appropriate to treat patients suffering from asthma. The usual drugs indicated in asthma treatment are reviewed. Precocious treatment with inhaled glucocorticosteroids is recommended by several authors.

Beta-lactam hypersensitivity: not always what it seems

Results One hundred and four children were evaluated with a suspected drug allergy history, with 28% reporting reactions to beta-lactam antibiotics. The mean age was 6.2 years and 52% were female. Cutaneous symptoms were the most frequent reported (89%), followed by respiratory (45%). Most of them had maculopapular exanthema (52%). Urticaria and/or angioedema were seen in 34% of patients. The majority of the reactions were mild/moderate (93%), occurring in the first 24 hours after drug intake (77%), and 48% presented associated fever. The suspected drugs were: amoxicilin (59%), cefalexin (16%), penicilin and ceftriaxone (8% each). Patients went to an Emergency Unit in 97% of the reactions and treated with anti-histaminic drugs and corticosteroids in 40% and 30% respectively. Epinephrine was used in just one patient. In almost half of the patients the clinical history was not consistent enough to submit them to an extensive investigation. Of those who were investigated, skin tests were performed in 48% (57% prick tests and 43% intradermal tests). Positive test was seen in only one patient (cefazolin). Drug provocation tests with amoxicilin were performed in 57% of patients and none was positive.

Hypersensitivity to non-steroidal anti-inflammatory drugs in pediatric patients

Results Medical records of 104 individuals with a history of hypersensitivity to drugs were analyzed. NSAIDs were the primarily suspected drug in 50% of the cases. The mean age was 10.9 years, with a predominance of males (57.7%). All patients had cutaneous manifestations and isolated angioedema was observed in the majority (53.8%); respiratory symptoms were reported in 44% of cases and gastrointestinal manifestations in 7.6%. Most of the patients reported reactions to more than one NSAID (71%) and dipyrone was the main drug reported in this group (34%), as in the group who had reactions to a single NSAID (73%). All reactions occurred in less than 24 hours after the drug use and 69.2% were of moderate severity. The ER was the main site searched for the treatment of the reactions (88%). During diagnostic investigation 38 oral provocation tests were performed, with positive results in 8 (5 ASA, 1 Ibuprofen, 1 Acetaminophen, 1 Dipyrone). Conclusions The reactions to NSAIDs in pediatric patients are more frequent in males. Angioedema alone was the main clinical manifestation and dipyrone the main drug involved in the reactions. The OPT proved to be an important tool to confirm or exclude the diagnosis of hypersensitivity, with the possibility of providing safer alternatives for those patients with proven reaction.