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This article investigates the tolerability of paracetamol in patients with a history of hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs). The study included 85 patients, with the majority being women and having a median age of 36 years. The most common symptoms of NSAID hypersensitivity were nasal inflammation, followed by respiratory and cutaneous symptoms. A paracetamol oral provocation test was conducted, and 11 cases of paracetamol intolerance were identified. The study suggests that a daily dose of over 1000 mg of paracetamol may be a risk factor for hypersensitivity reactions. The findings highlight the importance of evaluating paracetamol tolerance in patients with NSAID hypersensitivity to improve patient outcomes. [Extracted from the article]

DRESS related to first-line antituberculosis drugs (ATD) is a challenging diagnosis. With a long-lasting combined treatment of 4-concomitantly administrated drugs, identification of the culprit drug remains difficult and may expose patients to treatment interruption and affect their outcome. A 42-year-old female, treated with isoniazid, rifampicin, pyrazinamide and ethambutol for multifocal tuberculosis, developed, 40 days later, hyperthermia, facial edema, cervical lymphadenopathy and generalized exanthema. Biological test results revealed eosinophilia, atypical lymphocytes, and liver injury. DRESS was suspected, and ATD were withdrawn. As patch tests for the 4 ATD showed negative results, we decided to reintroduce pyrazinamide, ethambutol and rifampicin separately with a 3-day interval. Pyrazinamide and rifampicin were tolerated. However, after receiving ethambutol, she developed fever and generalized rash, with no biological abnormalities. Since ethambutol was claimed to be the culprit drug, isoniazid was added, and 10 hours later, the patient developed fever, facial edema, generalized rash, eosinophilia and liver injury. This clinical and biological pattern resolved 2 weeks later. This report suggests a hypersensitivity relapse to ethambutol after isoniazid-induced DRESS. [ABSTRACT FROM AUTHOR]

Background: Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe adverse drug reaction. It is uncommon in the paediatric population and can be difficult to diagnose as its initial symptoms may mimic a viral infection. Objective: To analyse the features of paediatric DRESS and to evaluate the interest of skin tests in identifying the causative drugs. Methods: It is a retrospective analysis (2004–2021) of DRESS cases diagnosed in paediatric patients. The DRESS diagnosis was defined using the RegiSCAR scoring. The skin tests were performed according to the ENDA recommendations. Results: We included 19 cases of DRESS occurred in 18 patients. Common clinical symptoms were exanthema and fever in 94.7% of cases each. The most commonly affected organ was the liver (84.2%). Among the implicated drugs, 16 were tested and skin tests were positive in 75%. To assess cross‐reactivity and co‐sensitization, skin tests with related and/or co‐administered drugs were performed in eight patients. Among them, only one child had positive results. Conclusion: Early diagnosis of DRESS and discontinuation of the incriminated drug might reduce the incidence of mortality in the paediatric population. Skin tests could be a safe and useful tool to identify the causative drug and assess cross‐reactivity. [ABSTRACT FROM AUTHOR]

The safety profile of the Sputnik V vaccine is generally reassuring. Nevertheless, an enhanced risk of new‐onset of immune‐mediated diseases has been increasingly reported following the adenoviral‐based Covid‐19 vaccine, including inflammatory arthritis, Guillain‐Barré syndrome, optical neuromyelitis, acute disseminated encephalomyelitis, subacute thyroiditis and acute liver injury as well as glomerulopathy. However, no case of autoimmune pancreatitis has been reported yet. Herein, we describe a case of type I autoimmune pancreatitis that may be due to the Sputnik V Covid‐19 vaccine. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti‐inflammatory drugs (NSAIDs) are among the main causes of fixed drug eruption (FDE). Cross‐sensitivity between chemically unrelated NSAIDs has been rarely described in FDE. We report herein two cases of NSAID‐induced FDE confirmed by oral provocation test (OPT) with a literature review. Case 1 is a 49‐year‐old woman who took mefenamic, naproxen and acetaminophen for lumbago. On the second day, she noticed three erythematous plaques, located in the upper lip, chin and the right hand, which faded spontaneously, leaving residual patches. Three months later, she took mefenamic acid with reactivation of the same plaques. She received naproxen. On the same day, she exhibited a reactivation of lesions with the development of a new one. These lesions have disappeared leaving hyperpigmented sequelae. After negative patch test to naproxen, an OPT was performed with positive reaction, observed on the third day. To establish the cross‐reactivity, she underwent OPTs, which gave positive results to indomethacin, ketoprofen and tiaprofenic acid. Case 2 is a 52‐year‐old woman who presented painful dusky‐red macules, located in the right and left wrists, 24 hours after taking mefenamic acid. She described two similar events that occurred in the past with an undefined drug and piroxicam. Patch tests to lysine acetylsalicylate, mefenamic acid, piroxicam, naproxen and celecoxib were negative. OPTs to the same NSAIDs gave positive results to lysine acetylsalicylate, piroxicam and mefenamic acid. Thirteen case reports, seven case series and one retrospective analysis, including cases with confirmed cross‐reactivity between NSAIDs, were reported in literature. Clinicians should be aware of such phenomenon. [ABSTRACT FROM AUTHOR]

Drug reaction with eosinophilia and systemic symptom (DRESS) is a severe adverse drug‐induced reaction. Commonly related to anticonvulsant and allopurinol, DRESS can affect both adults and children. Cefotaxime is rarely associated with DRESS, especially with children. We report a cefotaxime‐induced DRESS in a child and emphasize the role of allergological work‐up to point out the culprit drug in exploring cross‐reactivity and identifying a possible cosensitization. A 2‐year‐old boy was treated with cefotaxime, vancomycin and metronidazole for acute otomastoiditis. Metronidazole was withdrawn and vancomycin was changed by teicoplanin 10 and 15 days later, respectively. Nineteen days after ongoing cefotaxime and 4 days after teicoplanin intake, the patient developed hyperthermia, a widespread exanthema, facial oedema with neither mucosal involvement nor palpable lymphadenopathy. Biological tests revealed eosinophilia, atypical lymphocytes, mild cytolysis and a high lactate dehydrogenase level. Serological tests for viral and bacterial infections were negative. DRESS was suspected and the 2 antibiotics were withdrawn. Intradermal tests (IDT) were carried out 2 months later with cefotaxime and teicoplanin. They revealed a positive result at 48‐hour reading. To assess cross‐reactivity among β‐lactams, IDT to penicillins (benzylpenicillin, amoxicillin and oxacillin) was performed showing negative results at 48‐hour reading. Nevertheless, IDT to cephalosporins (cefazolin, cefuroxime, ceftazidime and ceftriaxone) displayed positive results at 48‐hour reading. As a result, IDT are of great interest and should be performed to confirm the role of cefotaxime and detect a potential cross‐reactivity with chemically similar drugs and drugs taken before and during the episode of DRESS. [ABSTRACT FROM AUTHOR]

Erythema nodosum (EN), the most common form of panniculitis, is a reactive inflammation of the subcutaneous fat clinically presented with a sudden onset of painful, erythematous, nodular, subcutaneous lesions, typically localized to the pretibial area. EN is commonly caused by numerous infections (especially beta‐haemolytic streptococcal infections), autoimmune diseases (sarcoidosis), inflammatory bowel conditions and drugs. EN induced by Covid‐19 vaccines is rarely reported. We describe an original clinical observation of a 75‐year‐old woman who presented with EN after receiving the second dose of BNT162b2, an mRNA vaccine. [ABSTRACT FROM AUTHOR]

Aims: To determine the frequency of an authentic β‐lactam (BL) hypersensitivity (HS) amongst a large number of children and to identify clinical risk factors that predict this hypersensitivity. Methods: All children with suspected BL allergy were evaluated by skin tests (ST) with the suspected BL. A 1‐day oral provocation test (OPT) was performed in children with negative ST. We defined an authentic BL‐HS case if the child exhibited a positive ST or a positive OPT. Risk factors associated with BL‐HS were assessed using a univariate analysis. Covariates showing a P‐value <.2 were included in the multivariate logistic regression analysis to determine independent predictors. Results: A total of 354 patients reporting 368 suspected BL reactions were included. The diagnosis of BL‐HS was established in 24 children (6.7%). All these children had a positive ST. OPT was performed in 30 patients and was negative in all of them. In 110 children with a negative ST, BL was tolerated. In the risk factors analysis, 164 children were included. Older age (>5 years) at the reaction (odds ratio = 1.11; 95% confidence interval, 1.01–1.22; P =.02) and BL administered (odds ratio = 7.7; 95% confidence interval, 2.76–21.8; P <.001) were significantly associated with authentic BL‐HS. Conclusion: BL‐HS should be evaluated with an appropriate allergy work‐up before strict prohibition is made. In addition, age of patient and BL involved can be used as predictive factors of developing BL‐HS in this population. [ABSTRACT FROM AUTHOR]

The anticonvulsant hypersensitivity syndrome, also known as drug rash eosinophilia and systemic symptoms (DRESS), is a rare but severe form of adverse cutaneous reaction. Several aromatic anticonvulsant drugs, such as carbamazepine (CBZ), phenytoin, or phenobarbital have been frequently associated with the onset of DRESS. Cross-reactivity among the aromatic anticonvulsants frequently occurs (40 to 80% of patients). However, cross reactivity with other drugs such as betalactams have exceptionally been reported. We report a clinical observation describing a DRESS associated with CBZ with a subsequent hypersensitivity to amoxicillin (AMX). A 34-year-old male with a 20-year history of epilepsy was treated with valproic acid and phenobarbital. As he had frequent convulsive fits, CBZ was added. Thirty-four days later, the patient developed hyperthermia (39.5°C), cervical lymphadenopathy, and generalized cutaneous exfoliated maculae and papulae. Biochemical investigation was characterized by a white cell count of (16.1 × 103/μL, 17% eosinophils) and increased levels of aspartate aminotransferase and alanine aminotransferase (50 and 116 IU/L, respectively). CBZ was discontinued. One month later, all the symptoms were progressively relieved. Six weeks after complete recovery, prick and patch skin tests were performed. They were strongly positive at 48-hour reading. About 2 years later, the patient exhibited an extensive pruritic skin rash, 2 days after AMX intake. Laboratory exams showed eosinophilia (7%) but neither elevated liver enzymes nor renal dysfunction. All these symptoms have disappeared 5 days after AMX withdrawal. Intradermal test to AMX was positive but not to other betalactams. Throughout this clinical observation, we report a CBZ-induced DRESS and describe the possibility of cross reactivity between CBZ and AMX. This cross reactivity was observed despite the lack of chemical similarity between both drugs. Keywords: hypersensitivity, amoxicillin, co-sensitization, DRESS, carbamazepine, skin tests