1/37. Drug-induced lung disease.Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/37. clindamycin hypersensitivity appears to be rare.BACKGROUND: A patient developed a generalized confluent erythematous papular rash after a single injection of clindamycin preoperatively. The literature from two small studies suggested a 10% incidence of cutaneous eruptions to clindamycin which seemed too high. OBJECTIVE: Describe a patient with clindamycin hypersensitivity and determine the incidence of hospital-wide adverse drug reactions from clindamycin from 1995-1997. methods: At a tertiary care center, utilizing the Department of Pharmacy records, the incidence of adverse drug reactions was determined with (1) voluntary physician reporting, (2) health information management chart reviews and adverse drug reaction coding, and (3) chart reviews by the pharmacy and therapeutics committee of adverse drug reactions. RESULTS: (I) A 50-year-old patient developed a generalized raised, erythematous rash that worsened over 3.5 days until hydrocortisone was administered. Immediate skin tests with clindamycin were negative. (2) From 3,896 administrations of clindamycin from April 1995 to October 1997, 14 (0.47%) adverse drug reactions occurred but 7 were confounded by other medications also being administered. CONCLUSION: (1) Adverse drug reactions to clindamycin are much lower than reported 25 years ago with an incidence < 1%. (2) A patient who previously had experienced facial edema and a generalized rash after receiving clindamycin and a cephalosporin 6 years ago and who was considered allergic to cephalosporins, was found to be clindamycin allergic when she received a preoperative dose of clindamycin.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/37. Anticonvulsant hypersensitivity syndrome.BACKGROUND: Anticonvulsant hypersensitivity syndrome (AHS) is a serious but poorly understood and little known disease. It has been variously described in the literature since 1934. Fatalities are rare but have been reported. methods: A medline search was undertaken from 1991 to present, using the keywords "anticonvulsant," "phenytoin," and "hypersensitivity." English language articles and their endnotes were reviewed, and neurologists, dermatologists, and specialists in hematology-oncology were consulted. RESULTS: A case of AHS is described. Investigators have reported epidemiologic data and described the pathophysiology, diagnostic criteria, and management options. CONCLUSIONS: family physicians should be aware of the AHS because of the high likelihood that patients with this syndrome will come first to their primary care physicians for care. Certain anticonvulsant medications have a high degree of cross-reactivity, the incidence of AHS is higher among first-degree relatives, and the disorder mimics systemic infection. If AHS is suspected, the antiepileptic drug should be discontinued. Supportive care should be directed to the appropriate organ systems, with particular attention to skin, eyes, and liver. Corticosteroid treatment might be effective in reversing the drug reactions, but it is not recommended in cases of suspected or actual infection because of the increased risk of immunocompromise, sepsis, and associated mortality.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/37. Frequency of systematic reactions to penicillin skin tests.BACKGROUND: Penicillin skin testing is generally considered to be safe when performed sequentially with puncture and intradermal testing although fatalities have been reported. OBJECTIVE: We analyzed the rate of systemic reactions to penicillin skin tests for a period of seven and two-thirds years. METHOD: This retrospective study used a computerized database at the Mayo Clinic. Altogether 1710 patients were skin-tested to penicillin from January 1992 to September 1999. All patients tested had a history of penicillin allergy. patients were tested with benzylpenicilloyl polylysine (Pre-Pen) (6.0 X 10(-5) M), freshly prepared penicillin g (10,000 units/ml), and penicilloate (0.01 M). Prick tests were done first and if negative then intradermal tests. Systemic reactions were evaluated and treated by physicians. RESULTS: Eighty-six patients had positive penicillin skin tests of which two had systemic reactions. Our systemic reaction rate for all patients tested was 0.12%; and 2.3% for the penicillin skin test-positive group, with no fatalities. CONCLUSION: The incidence of systemic reaction to penicillin skin tests is low. Skin prick tests should always be done first. If there is a history of a previous serious reaction, the skin tests-if done-should be diluted to start with. Those doing penicillin skin tests should be prepared to treat a systemic reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/37. Allergic reactions to isosulfan blue during sentinel node biopsy--a common event.BACKGROUND: Sentinel lymph node (SLN) dissection in the management of high-risk melanoma and other cancers, such as breast cancer, has recently increased in use. The procedure identifies an SLN by intradermal or intraparenchymal injection of an isosulfan blue dye, a radiocolloid, or both around the primary malignancy. methods: At the time of selective SLN mapping, 3 to 5 mL of isosulfan blue was injected either intradermally or intraparenchymally around the primary malignancy. From October 1997 to May 2000, 267 patients underwent intraoperative lymphatic mapping with the use of both isosulfan 1% blue dye and radiocolloid injection. Five cases with adverse reactions to isosulfan blue were reviewed. RESULTS: We report 2 cases of anaphylaxis and 3 cases of "blue hives" after injection with isosulfan blue of 267 patients who had intraoperative lymphatic mapping by the procedure described above. The 2 patients with anaphylaxis experienced cardiovascular collapse, erythema, perioral edema, urticaria, and uvular edema. The blue hives in 3 patients resolved and transformed to blue patches during the course of the procedures. CONCLUSIONS: The incidence of allergic reactions in our series was 2.0%. As physicians expand the role of SLN mapping, they should consider the use of histamine blockers as prophylaxis and have emergency treatment readily available to treat the life- threatening complication of anaphylactic reaction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/37. Anaphylactic shock following oral penicillin--report of two cases.Two cases of anaphylactic shock secondary to oral penicillin therapy are presented. The clinical course and treatment of the two patients are discussed. Ways in which physicians and pharmacists may reduce the incidence and severity of anaphylactic reactions to penicillin are reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/37. Ocular complications of the Fernand-Widal triad and its therapy.BACKGROUND: The Fernand-Widal triad (FWT) is the association of non-allergic intrinsic asthma, nasal polyposis and sensitivity to aspirin. The aim of this paper is to describe the possibility of ocular complications, which we found in 3 cases: in 1 case due to the FWT itself and in the other 2 as a result of corticosteroid treatment. methods: Three cases of the FWT with ocular complications were studied, and the pertinent literature was reviewed. RESULTS: No previous description of ocular involvement in individuals with FWT was found in the literature. In the first case, episodes of orbital cellulitis due to superinfected nasal polyposis were found as a complication produced by the disease. In the other 2 cases, corticosteroid treatment created complications: ocular hypertension in both cases and bilateral subcapsular cataracts in 1 case. CONCLUSIONS: Although not rare, the diagnosis of the FWT is often missed. This perhaps explains why no report of ocular complications has yet been published in the literature. Because of the serious clinical consequences, physicians involved in the treatment of these patients should be aware of this diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/37. Psychiatric treatments in multiple chemical sensitivity.Despite the controversy and uncertainty surrounding the causes of the MCS syndrome, psychiatric treatments may provide some relief to MCS patients. These approaches may help patient and physician focus on the most important goals: relief of symptoms and improvement of function. Success requires that physician and patient establish a collaborative relationship and negotiate a treatment plan. Behavioral treatments are most effective at reducing disability and promoting a return to active life. When directed at appropriate target symptoms, psychopharmacologic treatments may reduce some of the most distressing symptoms of chemical sensitivity.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
9/37. hypersensitivity reaction associated with acute hepatic dysfunction following a single intravenous dose of procainamide.Rare cases of hepatotoxicity have been attributed to the antiarrhythmic agent procainamide. We here describe the case of a patient who had a hypersensitivity reaction to procainamide with fever, chills, arthralgia, abdominal pain and acute elevations of serum aminotransferase activities and bilirubin concentration. The reaction occurred after the patient had received a large intravenous dose during cardiac electrophysiological testing. This case should alert physicians to potential hepatotoxic reactions to procainamide, particularly with the increasing popularity of cardiac electrophysiological testing, during which this drug is commonly used.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/37. cefazolin tolerance does not predict ceftriaxone hypersensitivity: unique side chains precipitate anaphylaxis.A 48-year-old woman with a questionable history of an unspecified ceftriaxone allergy was treated with cefazolin for surgical antibiotic prophylaxis. After she tolerated cefazolin therapy for 4 days, the medical staff concluded that her allergy history was inaccurate, and she was treated with intravenous ceftriaxone for suspected nosocomial pneumonia. Approximately 10 minutes after the start of the infusion, the patient experienced anaphylaxis. Initial symptoms of oral angioedema and laryngopharyngeal constriction progressed to dyspnea, tachypnea, hypotension, and tachycardia, all of which quickly resolved after immediate treatment with hydrocortisone, diphenhydramine, and epinephrine. Skin testing with cefazolin, cefepime, and ceftriaxone revealed that the likely allergic determinant mediating the patient's hypersensitivity reaction was the unique ceftriaxone R2 side chain and not the beta-lactam ring, which initially was suspected by the physician. immunoglobulin e-mediated hypersensitivity reactions to cephalosporins may occur due to antibody complexes with the beta-lactam ring or various cephalosporin side chains. Misconceptions regarding the nature of cephalosporin allergies complicate antibiotic selection for patients with questionable allergy histories and may lead to inappropriate drug reexposure and anaphylaxis. Detailed understanding of the antigenic determinants that mediate hypersensitivity reactions is essential for clinicians to avoid type 1 reactions in patients with a suspected allergy to cephalosporins.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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