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2 results on '"Anca Mirela Chiriac, MD, PhD"'

1. Hypersensitivity reactions to iodinated radiocontrast media: Cluster analysis reveals distinct clinical phenotypes

Author

Witchaya Srisuwatchari, MD, Tram Vo, MD, Amélie Gauthier, MD, Nicolas Molinari, PhD, Rik Schrijvers, MD, PhD, Pascal Demoly, MD, PhD, and Anca Mirela Chiriac, MD, PhD

Subjects
Iodinated radiocontrast media, Drug hypersensitivity reaction, Clinical phenotype, Cluster analysis, Immunologic diseases. Allergy, RC581-607
Abstract

Background: Drug hypersensitivity reaction (DHR) to iodinated radiocontrast media (iRCM) is reported in 1%–3% of injections. Risk assessment of patients with suspicion of DHR to iRCM relies solely on clinical phenotyping and drug allergy workup. Using a novel unsupervised TwoStep cluster analysis, we aimed to identify prototypic patterns within a large cohort of patients evaluated for a potential iRCM DHR. Methods: A retrospective study was conducted using data from the Drug Allergy and Hypersensitivity Database of the Allergy Unit, University Hospital of Montpellier, Montpellier, France. All referred patients during February 2001 to December 2019 with suspicion of iRCM DHR with either confirmed positive or confirmed negative skin tests were included in the analysis. Results: A total of 1439 patients were evaluated. The chronology of the index reaction was immediate and nonimmediate in 77.1% and 22.4%, respectively. Cluster analysis categorized the total study population in 5 clusters. Cluster 1 compiled all nonimmediate and cluster 2–5 almost all immediate reactors. Cluster 1 and 2 had recent reactions (

Published
2022
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2. Standards for practical intravenous rapid drug desensitization & delabeling: A WAO committee statement

Author

Emilio Alvarez-Cuesta, MD, PhD, MQM, Ricardo Madrigal-Burgaleta, LMS, MD, PhD, Ana D. Broyles, MD, Javier Cuesta-Herranz, MD, PhD, Maria Antonieta Guzman-Melendez, MD, PhD, Michelle C. Maciag, MD, Elizabeth J. Phillips, MD, Jason A. Trubiano, MBBS, PhD, Johnson T. Wong, MD, Ignacio Ansotegui, MD, PhD, F. Runa Ali, MBBS, PhD, FRCP, Denisse Angel-Pereira, MD, Aleena Banerji, MD, Maria Pilar Berges-Gimeno, MD, PhD, Lorena Bernal-Rubio, MD, Knut Brockow, MD, Ricardo Cardona Villa, MD, Mariana C. Castells, MD, PhD, Jean-Christoph Caubet, MD, Yoon-Seok Chang, MD, PhD, Luis Felipe Ensina, MD, MSc, PhD, Manana Chikhladze, PhD, Anca Mirela Chiriac, MD, PhD, Weng-Hung Chung, MD, PhD, Motohiro Ebisawa, MD, PhD, Bryan Fernandes, MBBS, MRCP, Lene Heise Garvey, MD, PhD, Maximiliano Gomez, MD, PhD, Javier Gomez Vera, MD, Sandra Gonzalez Diaz, MD, PhD, David I. Hong, MD, Juan Carlos Ivancevich, MD, Hye-Ryun Kang, MD, PhD, David A. Khan, MD, Merin Kuruvilla, MD, Jose Ignacio Larco Sousa, MD, Patricia Latour-Staffeld, MD, Anne Y. Liu, MD, Eric Macy, MD, Hans Jorgen Malling, MD, Jorge Maspero, MD, Sara M. May, MD, Cristobalina Mayorga, PhD, Miguel A. Park, MD, Jonathan Peter, MBChB, PhD, Matthieu Picard, MD, FRCPC, Tito Rodriguez-Bouza, MD, PhD, Antonino Romano, MD, Mario Sanchez-Borges, MD, Luciana Kase Tanno, MD, PhD, Maria Jose Torres, MD, PhD, Alicia Ureña-Tavera, MD, Rocco L. Valluzzi, MD, Gerald W. Volcheck, MD, and Masao Yamaguchi, MD, PhD

Subjects
Drug allergy, Drug desensitization, Drug challenge, Drug provocation test, Delabeling, Chemotherapy, Immunologic diseases. Allergy, RC581-607
Abstract

Drug hypersensitivity reactions (DHRs) to intravenous drugs can be severe and might leave patients and doctors in a difficult position where an essential treatment or intervention has to be suspended. Even if virtually any intravenous medication can potentially trigger a life-threatening DHR, chemotherapeutics, biologics, and antibiotics are amongst the intravenous drugs most frequently involved in these reactions. Admittedly, suspending such treatments may negatively impact the survival outcomes or the quality of life of affected patients.Delabeling pathways and rapid drug desensitization (RDD) can help reactive patients stay on first-choice therapies instead of turning to less efficacious, less cost-effective, or more toxic alternatives. However, these are high-complexity and high-risk techniques, which usually need expert teams and allergy-specific techniques (skin testing, in vitro testing, drug provocation testing) to ensure safety, an accurate diagnosis, and personalized management. Unfortunately, there are significant inequalities within and among countries in access to allergy departments with the necessary expertise and resources to offer these techniques and tackle these DHRs optimally.The main objective of this consensus document is to create a great benefit for patients worldwide by aiding allergists to expand the scope of their practice and support them with evidence, data, and experience from leading groups from around the globe.This statement of the Drug Hypersensitivity Committee of the World Allergy Organization (WAO) aims to be a comprehensive practical guide on the technical aspects of implementing acute-onset intravenous hypersensitivity delabeling and RDD for a wide range of drugs. Thus, the manuscript does not only focus on clinical pathways. Instead, it also provides guidance on topics usually left unaddressed, namely, internal validation, continuous quality improvement, creating a healthy multidisciplinary environment, and redesigning care (including a specific supplemental section on a real-life example of how to design a dedicated space that can combine basic and complex diagnostic and therapeutic techniques in allergy).

Published
2022
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