Search

In drug hypersensitivity, drug provocation testing (DPT), also called drug challenge, is the gold standard for investigation. In recent years, risk stratification has become an important tool for adjusting the diagnostic strategy to the perceived risk, whilst still maintaining a high level of safety for the patient. Skin tests are recommended before DPT but may be omitted in low‐risk patients. The task force suggests a strict definition of such low‐risk patients in children and adults. Based on experience and evidence from studies of allergy to beta‐lactam antibiotics, an algorithm on how to adjust DPT to the risk, and when to omit skin tests before DPT, is presented. For other antibiotics, non‐steroidal anti‐inflammatory drugs and other drugs, skin tests are poorly validated and DPT is frequently necessary. We recommend performing DPT with chemotherapeutics and biologicals to avoid unnecessary desensitization procedures and DPT with skin tests negative contrast media. We suggest DPT with anesthetics only in highly specialized centers. Specifics of DPT to proton pump inhibitors, anticonvulsants and corticosteroids are discussed. This position paper provides general recommendations and guidance on optimizing use of DPT, whilst balancing benefits with patient safety and optimizing the use of the limited available resources. [ABSTRACT FROM AUTHOR]

Proton pump inhibitors (PPIs) are invaluable therapeutic options in a variety of dyspeptic diseases. In addition to their well‐known risk profile, PPI consumption is related to food and environmental allergies, dysbiosis, osteoporosis, as well as immediate and delayed hypersensitivity reactions (HSRs). The latter, although a rare event, around 1%–3%, due to the extraordinarily high rate of prescription and consumption of PPIs are related to a substantial risk. In this Position Paper, we provide clinicians with practical evidence‐based recommendations for the diagnosis and management of HSRs to PPIs. Furthermore, the unmet needs proposed in the document aim to stimulate more in‐depth investigations in the topic. [ABSTRACT FROM AUTHOR]

Diagnosing immediate drug hypersensitivity reactions (IDHRs) can pose a significant challenge and there is an urgent need for safe and reliable tests. Evidence has emerged that the basophil activation test (BAT), an in vitro assay that mirrors the in vivo response, can be a complementary test for many drugs. In this position paper, members of Task Force (TF) "Basophil activation test in the evaluation of Drug Hypersensitivity Reactions" from the European Academy of Allergy and Clinical Immunology (EAACI) present the data from a survey about the use and utility of BAT in IDHRs in Europe. The survey results indicate that there is a great interest for using BAT especially for diagnosing IDHRs. However, there are still main needs, mainly in the standardization of the protocols. Subsequently consensus‐based recommendations were formulated for: (i) Technical aspects of BAT in IDHRs including type of sample, management of drugs, flow cytometry protocols, interpretation of the results; and (ii) Drug‐specific aspects that should be taken into account when performing BAT in relation to betalactams, neuromuscular blocking agents, fluoroquinolones, chlorhexidine, opioids, radio contrast media, chemotherapeutics, biological agents, nonsteroidal anti‐inflammatory drugs, COVID vaccine, and excipients. Moreover, aspects in the evaluation of pediatric population have also been considered. All this indicates that BAT offers the clinician and laboratory a complementary tool for a safe diagnostic for IDHRs, although its place in the diagnostic algorithm depends on the drug class and patient population (phenotype, geography, and age). The standardization of BAT is important for generalizing this method beyond the individual laboratory. [ABSTRACT FROM AUTHOR]

Objective: To analyse the clinical characteristics and sensitivity of an essential oil patch test series (EOS) in patients sensitized to their own essential oils (EOs). Method: We analysed the clinical data and patch test results obtained with the European baseline series (BSE) and an EOS, as well as the mode of use of EOs, through a questionnaire included in the patient file. Results: The study included 42 patients (79% women, average age 50 years) with allergic contact dermatitis (ACD), 8 patients required hospitalization. All patients were sensitized to the EO they used, primarily lavender (Lavandula augustifolia, 8000‐28‐0), tea tree (Melaleuca alternifolia leaf oil, 68647‐73‐4), ravintsara (Cinnamomum camphora oil, 92201‐50‐8), and 2 cases were attributed to helichrysum (helichrysum italicum flower absolute, 90045‐56‐0). 71% had positive patch tests to fragrance mix I or II, 9 only to the EOS and 4 only with their personal EO. Interestingly, 40% of patients did not spontaneously mention the use of EOs, and only 33% received advice on their use at the time of purchase. Conclusion: Patch tests with the BSE, limonene and linalool HP, and oxidized tea tree oil is sufficient to detect most EO‐sensitized patients. The most important is to test the patient's own used EOs. [ABSTRACT FROM AUTHOR]

In 145 patients, revaccination was performed with the culprit vaccine, which was well tolerated in 126 of the patients, and 15 of the patients had an alternative COVID-19 vaccine (other mRNA vaccine for 12), which was well tolerated in 13 of the patients (Figure 1). Keywords: allergy; anaphylaxis; COVID-19-mRNA vaccines EN allergy anaphylaxis COVID-19-mRNA vaccines 2320 2323 4 08/02/23 20230801 NES 230801 To the Editor, The mechanisms of allergic reactions to COVID-19-mRNA vaccines have not been elucidated. One hundred and sixty patients (84%) were revaccinated (122 under antihistamine premedication), 139 patients (87%) had good tolerance, and 30 patients refused further COVID-19 vaccination. [Extracted from the article]

Keywords: allergic contact dermatitis; CAS no. 78336-31-9; case report; copolymers; cosmetic products; PEG-22/dodecyl glycol copolymer; PEG-45/dodecyl glycol copolymer EN allergic contact dermatitis CAS no. 78336-31-9 case report copolymers cosmetic products PEG-22/dodecyl glycol copolymer PEG-45/dodecyl glycol copolymer 213 215 3 08/04/23 20230901 NES 230901 We report a case of allergic contact dermatitis (ACD) caused by PEG-22/dodecyl glycol copolymer and PEG-45/dodecyl glycol copolymer contained in two different "skin-repairing" creams. Allergic contact dermatitis, CAS no. 78336-31-9, case report, copolymers, cosmetic products, PEG-22/dodecyl glycol copolymer, PEG-45/dodecyl glycol copolymer Allergic contact dermatitis caused by PEG-22 and PEG-45 dodecyl glycol copolymers in two skin-repairing creams. [Extracted from the article]

The relatively lower crystallinity and random orientation of quantum well structures hinder carrier transport and limit the performance of formamidinium (FA) based low‐n 2D perovskite devices. In this work, the crystallization and quantum well orientation are fine tuned to achieve efficient low‐n FA based Ruddlesden–Popper perovskite solar cells. The effects of different ionic additives on the crystallization, orientation, and photovoltaic performance of FA based low‐n 2D perovskites are comparatively investigated. It is found that NH4+ and SCN− can significantly retard the heterogeneous crystallization of low‐n phases in the intermediate state, and drive the templated growth of quantum well structure with vertical orientation. The optimized photovoltaic device based on (BA)2(FA)3Pb4I13 achieved a power conversion efficiency (PCE) of 18.14%, setting the highest record for FA‐based low‐n 2D perovskite solar cells as far as it is known (average n = 4). The unencapsulated device exhibited excellent stability and maintained 93.3% of its original PCE at 85 °C, and 86.3% at 1 Sun illumination after 720 h in humid ambient condition. [ABSTRACT FROM AUTHOR]

Background and Aims: Vitamins are bioactive compounds naturally found in many different types of food and required by the human body for many biological functions and enzymatic activities. Due to their antioxidant properties, certain vitamin derivatives have been synthesized for inclusion in many cosmetics, thus leading to an increasing incidence of allergic contact dermatitis (ACD) cases. Therefore, the present review may be helpful to provide an insight into the sensitizing role of at least certain vitamins and may also offer possible patch test alternatives for definitive diagnosis. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. Literature search regarding ACD cases to vitamins was performed using the Medline, PubMed, Scopus, EMBASE, and Google Scholar databases from January 1940 up to June 2021. Results: A total of 4494 articles matched the keywords used for the researched. Records removed before screening included 15 duplicate articles and 3429 not eligible articles (e.g., not written in English, studies on animals, not relevant to the topic). A total of 1050 articles underwent the screening phase and 258 were therefore excluded as they were not primary studies. Subsequentially, 792 articles were considered eligible for the review and 688 of them were finally excluded as they did not report the outcome of interest. Therefore, 104 articles were definitely included in the present review. Conclusion: ACD to vitamins is still probably an underestimated issue in cosmetology, as many vitamins are considered "natural" and therefore "safe" ingredients. On the contrary, according to current literature, almost all vitamins contained in topical products are able to induce allergic reactions, with the exception of vitamin B2 and vitamin B9. Patch tests are not standardized, thus leading to difficulties in diagnosis. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis, which is rare, has been reported after COVID‐19 vaccination, but its management is not standardized. Method: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre‐vaccination screening and management of allergic reactions to COVID‐19 vaccines, and literature was analysed. Results: No death due to anaphylaxis to COVID‐19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1—anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2—anaphylaxis to oral/topical PEG containing products; 3—recurrent anaphylaxis of unknown cause; 4—suspected or confirmed allergy to any mRNA vaccine; and 5—confirmed allergy to PEG or derivatives. We recommend a prick‐to‐prick skin test with the left‐over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. Conclusions: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID‐19 vaccines and enable more people with history of allergy to be vaccinated. [ABSTRACT FROM AUTHOR]

Background and Objectives: The repeated open application test (ROAT) is an adjuvant investigation measure to patch testing in the diagnosis of allergic contact dermatitis. ESCD recommends a 15 days duration but its overall duration varies according to publications and patients hardly adhere to prolonged ROAT duration beyond 1 week. Materials and Methods: The Dermatology and Allergy Group of the French Society of Dermatology performed a prospective study with the aim of determining the best duration for the ROAT. Results: A total of 328 ROAT results were collected for topical products, including cosmetics (60%) and topical medications (31.1%). Fifty‐nine (18%) ROATs were positive, and 16 (5%) were doubtful. All the positive ROATs occurred within 10 days, with a median time to positivity of 3 days. Conclusion: According to our results, a minimum duration of 10 days is necessary to achieve a positive ROAT to a topical product. [ABSTRACT FROM AUTHOR]

Background: An aqueous antiseptic containing "chlorhexidine digluconate/benzalkonium chloride/benzyl alcohol" (CBB) is widely used in France. The only previous documented study dealing with allergic contact dermatitis (ACD) to this antiseptic is one small case series in children. The French Vigilance Network for Dermatology and Allergy (REVIDAL‐GERDA) has collected many cases in the last few years. Objectives: To evaluate the clinical and sensitization profiles of patients diagnosed with ACD to CBB. Methods: We performed a retrospective study of patients with contact dermatitis to CBB and positive tests to CBB and/or at least one of its components. All patients had to be tested with all components of CBB. Results: A total of 102 patients (71 adults and 31 children) were included. The lesions were extensive in 63% of patients and 55% had delayed time to diagnosis. CBB patch tests were positive in 93.8% of cases. The allergen was identified in 97% of patients, mainly benzyl alcohol in adults (81.7%) and chlorhexidine digluconate in children (54.8%). About 32.4% of the patients were sensitized to several components. Conclusion: CBB is a cause of ACD at all ages. The components of the antiseptic should be tested. The sensitization profile seems to be different between adults and children. [ABSTRACT FROM AUTHOR]

Skin tests, including patch tests (PTs), prick tests, and intradermal tests (IDTs), are useful in identifying the culprits of cutaneous adverse drug reactions (CADRs), and determining safer, alternative drugs. PTs have a low sensitivity but are valuable in investigating maculopapular exanthema (MPE), as well as severe CADR, including toxic epidermal necrolysis (TEN), Stevens‐Johnson syndrome (SJS), and in particular, acute generalized exanthematous pustulosis (AGEP), and drug reaction with eosinophilia and systemic symptoms (DRESS). To ensure their specificity, at least 10 control tests should be performed. Prick tests are mainly used in the evaluation of immediate‐type hypersensitivity and can be performed with all drugs, except opiates. IDTs can be used to explore immediate and delayed‐type hypersensitivity, if an injectable form of the drug exists. Except for SJS/TEN, IDTs should be performed by injecting 0.02 mL of the drug. We here provide a practical, up‐to‐date review on the use of these skin tests in the work‐up of CADRs. Numerous negative controls for drug PTs, as well as criteria for the immediate and delayed positivity of prick tests and IDT, are included. It should be emphasized that a negative result never excludes the potential responsibility of a drug in a CADR. [ABSTRACT FROM AUTHOR]

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID‐19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID‐19 vaccines due to high risk of death. In very rare instances, the COVID‐19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA‐EAACI‐EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID‐19 vaccines. Anaphylaxis to COVID‐19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients. [ABSTRACT FROM AUTHOR]

Several complications have been described, including intravascular injection of hyaluronic acid (HA).[1] Current management of intravascular HA injection is based on early injection of hyaluronidase[2] which should be performed as soon as possible and mandatorily within 72 h of the procedure. A 54-year-old woman, who had received a well-tolerated HA injection 3 years earlier, underwent bilateral HA injections into the nasolabial folds at a private dermatologist's office. Intra-arterial facial injection of hyaluronic acid complicated by Nicolau's dermatitis: Treatment with iloprost. [Extracted from the article]

Colchicine appeared to be more effective in cases of significant neutrophilic infiltrate: 42.85% effectiveness in NU group (clinical remission in 12 patients) versus 6.25% in CSU group. Neutrophilic urticaria was defined by an inflammatory dermal infiltrate composed of at least 60% PNN, without leukocytoclasia/vasculitis, averaging 50% and 70% reported in the literature,4,5 which is more reliable than a number of PNN per field of observation. Neutrophilic Urticaria or Urticaria With Predominantly Neutrophilic Inflammatory Infiltrate: Study of Its Clinical and Histopathologic Characteristics and Its Possible Association With Rheumatic Disease. [Extracted from the article]

(C) Positive prick test with undiluted Desomedine on delayed reading at day 2 (same prick test as in B) gl Prick tests were performed with undiluted Desomedine (hexamidine 0.1%), and these confirmed both immediate and delayed type hypersensitivity on immediate (Figure 1B) and delayed readings on day (D)2 (Figure 1C). Although allergic contact dermatitis in response to antiseptics is common, we should be aware that occasionally this may co-exist with immediate-type hypersensitivity, and also with molecules frequently sold over the counter. Keywords: case report; delayed hypersensitivity; hexamidine; immediate hypersensitivity EN case report delayed hypersensitivity hexamidine immediate hypersensitivity 580 582 3 10/22/21 20211101 NES 211101 CASE REPORT A 66-year-old man with a history of arterial hypertension (treated by dietary approaches only), allergic rhinitis, asthma, and atopic dermatitis, developed a grade II anaphylactic reaction 5 minutes after the first intranasal application of hexamidine (Desomedine, Chauvin Bausch & Lomb laboratory, Montpellier, France) for a cold. [Extracted from the article]

Four pediatric patients with SLC29A3 mutations treated with tocilizumab (anti-IL-6 receptor) have been reported.2,3 We report the first case of adult HS successfully treated with tocilizumab. Dear Editor, H syndrome (HS) is a rare autosomal recessive genodermatosis due to a mutation in the gene SLC29A3 encoding for the human equilibrative nucleoside transporter-3 (hENT3). New treatment options are necessary for HS because of its potential major functional impact. [Extracted from the article]

Allergic contact dermatitis, case report, cosmetics, patch tests A 53-year-old woman experienced a widespread eczema after application of two Tamanu oils on insect bites, with positive patch test results to the two Tamanu oils at 1% in olive oil. Keywords: allergic contact dermatitis; case report; cosmetics; patch tests EN allergic contact dermatitis case report cosmetics patch tests 99 100 2 06/14/22 20220701 NES 220701 Allergic contact dermatitis (ACD) to Tamanu oil is rare, but two recent cases underline that an increase in frequency of use could bring out more cases of ACD to this vegetable oil. [Extracted from the article]

This document is a letter to the editor discussing paradoxical urticaria reactions to H1-antihistamines. The authors report on nine patients with paradoxical urticaria who experienced hives from different classes of H1-antihistamines. The cause of this reaction is still unclear, but it may be related to mast cell degranulation or disruption of the arachidonic acid metabolism pathway. Physicians should be aware of this diagnosis and perform an allergy work-up, including skin testing, in patients suspected of having paradoxical urticaria. The letter includes a table summarizing the clinical characteristics and allergy work-up of the identified cases. [Extracted from the article]

Acute generalized exanthematous pustulosis (AGEP) is a rare, usually drug‐induced, acute pustular rash. Despite the lack of strong data supporting the effectiveness of topical or systemic corticosteroids in this drug reaction, they are widely used. More generally, there is no consensus on the diagnostic modalities and the management of patients with AGEP. We aimed to provide European expert recommendations for the diagnosis and management or patients with AGEP. Members of the ToxiTEN group of the European Reference Network (ERN)‐skin, all dermatologists and/or allergologists with expertise in drug reactions, elaborated these recommendations based on their own experience and on a review of the literature. Recommendations were separated into the following categories: professionals involved, assessment of the diagnosis of AGEP, management of the patient and allergological work‐up after the acute phase. Consensus was obtained among experts for the list of professionals involved for the diagnosis and management of AGEP, including the minimum diagnostic work‐up, the setting of management, the treatments, the modalities and the timing of allergological work‐up and follow‐up. European experts in drug allergies propose herein consensus on the diagnosis and management of patients with AGEP. A multidisciplinary approach is warranted, including dermatologists, allergologists and pharmacovigilance services. [ABSTRACT FROM AUTHOR]

This article discusses the emergence of doxycycline-induced fixed drug eruption (FDE), a common adverse reaction characterized by red patches on the skin or mucosa. FDE is typically associated with drugs like paracetamol, antibiotics, and non-steroidal anti-inflammatory drugs. However, recent cases have shown that doxycycline, commonly used for post-exposure prophylaxis (PeP) against sexually transmitted infections (STIs), can also induce FDE. The article presents 15 cases of doxycycline-induced FDE, with most cases occurring within the past 6 months. The authors recommend in situ repeated open application tests (ROAT) to confirm the diagnosis and avoid oral provocation tests (OPT), which can carry risks. They also suggest that all cyclin antibiotics, including doxycycline, be contraindicated for safety reasons. The article emphasizes the importance of recognizing doxycycline-induced FDE, particularly in cases of genital lesions that could be misdiagnosed as STIs. [Extracted from the article]