1,157 results on '"Hypersensitivity drug reactions"'
Search Results
2. Correction to: Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions
- Author
-
Koumaki, Dimitra, Gregoriou, Stamatios, Evangelou, Georgios, Katoulis, Alexander, Papadakis, Marios, Krueger-Krasagakis, Sabine Elke, Doxastaki, Aikaterini, Mylonakis, Dimitrios, and Krasagakis, Konstantinos
- Published
- 2024
- Full Text
- View/download PDF
3. Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions
- Author
-
Dimitra Koumaki, Stamatios Gregoriou, Georgios Evangelou, Alexander Katoulis, Marios Papadakis, Sabine Elke Krueger-Krasagakis, Aikaterini Doxastaki, Dimitrios Mylonakis, and Konstantinos Krasagakis
- Subjects
Anaphylaxis ,Angioedema ,Basophil activation test ,Hypersensitivity ,Immediate drug reaction ,Dermatology ,RL1-803 - Abstract
Abstract Introduction The basophil activation test (BAT) is a flow cytometry laboratory technique that assesses the level of activation indicators expressed on the surface of basophils. We conducted a real-life study in a prospective cohort of patients with reported drug hypersensitivity reactions to determine the true relevance of BAT as a diagnostic tool for assessing immediate hypersensitivity reactions to medicines. Methods We prospectively assessed individuals with clinical suspicion of immediate hypersensitivity reactions to drugs over a 2-year period. The allergological evaluation was carried out in accordance with European Academy of Allergy and Clinical Immunology (EAACI) guidance. All patients underwent BAT using the activation marker CD63. Results In total 13 patients with 54 reported immediate drug hypersensitivity reactions to medications were included in this study. Twelve were female (92.3%) and one was male (7.70%). The mean ± SD age of the patients was 47.31 ± 19.94 years. Antibiotics were tested in 35.2% (19/54) of patients, corticosteroids in 24.1% (13/54), iodinated contrast medium in 14.8% (8/54), and NSAIDs in 5.6% (3/54). There was no correlation between the BAT results and the age of patients, gender, type of medication, or time interval between the allergic reaction and BAT procedure. The sensitivity of BAT 5% CD63+ basophils to drugs was 97.6%, specificity was 96% for drug allergies, positive predictive value (PPV) was 94.3%, and negative predictive value (NPV) was 95.2%. Conclusions The sensitivity of BAT for drug allergies is limited, but it can nevertheless be very helpful before contemplating provocation testing in cases of life-threatening drug allergies where patients cannot be rechallenged or in cases of medications for which no other tests are available or their results are ambiguous.
- Published
- 2023
- Full Text
- View/download PDF
4. Ibuprofen and Other Arylpropionics: The Relevance in Immediate Hypersensitivity Drug Reactions.
- Author
-
Blanca-Lopez, Natalia, Agundez, Jose A.G., Fernández, Javier, García-Martin, Elena, and Blanca, Miguel
- Subjects
- *
DRUG side effects , *MEDICAL prescriptions , *DRUG allergy , *ANTI-inflammatory agents , *ALLERGIES , *URTICARIA - Abstract
Background: Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is the most frequent medication to be involved in hypersensitivity drug reactions (HDRs). Other analgesic/anti-inflammatory drugs in the arylpropionic group are also relevant, albeit to a lesser extent. Ibuprofen is widely consumed by people of all ages, both on medical prescription and over the counter; moreover, it is an organic contaminant of surface waters and foods. While numerous drugs cause HDR, ibuprofen's underlying mechanisms are more intricate and involve both specific immunological and non-immunological mediated reactions. Summary: we concentrate on immediate responses, including urticaria with or without angioedema, anaphylaxis, and angioedema, classifying reactions according to whether they are caused by single or multiple NSAIDs and based on the mechanisms at play. Both groups may experience anaphylaxis, defined as an immediate, severe systemic reaction involving at least two organs, though the frequency and severity can vary. Following this classification, more clinical manifestations can be identified. Diagnosis is partly based on a detailed clinical history, including information about ibuprofen and/or other arylpropionic derivatives involved, the interval between drug intake and symptoms onset, clinical manifestations, number of episodes, and the patient's tolerance or response to other medications – mainly non-chemically related NSAID – both before and after reactions to ibuprofen and/or other arylpropionic drugs. A drug provocation test is frequently necessary to make a diagnosis. Key Message: Because ibuprofen is the most widely prescribed NSAID, it is reasonable to assume its role as the leading cause of HDR will only become more important. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
5. Correction to: Real-Life Utility of Basophil Activation Test in the Diagnosis of Immediate Hypersensitivity Drug Reactions
- Author
-
Dimitra Koumaki, Stamatios Gregoriou, Georgios Evangelou, Alexander Katoulis, Marios Papadakis, Sabine Elke Krueger-Krasagakis, Aikaterini Doxastaki, Dimitrios Mylonakis, and Konstantinos Krasagakis
- Subjects
Dermatology ,RL1-803 - Published
- 2024
- Full Text
- View/download PDF
6. Pharmacogenetics of hypersensitivity drug reactions
- Author
-
Negrini, Simone and Becquemont, Laurent
- Published
- 2017
- Full Text
- View/download PDF
7. Role of pharmacogenomics in T-cell hypersensitivity drug reactions
- Author
-
Hertzman, R.J., Deshpande, P., Gibson, A., Phillips, E.J., Hertzman, R.J., Deshpande, P., Gibson, A., and Phillips, E.J.
- Abstract
Purpose of review An update of the pharmacogenetic risk factors associated with T-cell-mediated delayed hypersensitivity reactions. Recent findings Recent HLA associations relevant to our understanding of immunopathogenesis and clinical practice include HLA-B∗13:01 with co-trimoxazole-induced SCAR, and HLA-A∗32:01 with vancomycin-DRESS, for which an extended HLA class II haplotype is implicated in glycopeptide antibiotic cross-reactivity. Hypoactive variants of ERAP1, an enzyme-trimming peptide prior to HLA loading, are now associated with protection from abacavir-hypersensitivity in HLA-B∗57:01+ patients, and single-cell sequencing has defined the skin-restricted expansion of a single, public and drug-reactive dominant TCR across patients with HLA-B∗15:02-restricted carbamazepine-induced SJS/TEN. More recent strategies for the use of HLA and other risk factors may include risk-stratification, early diagnosis, and diagnosis in addition to screening. Summary HLA is necessary but insufficient as a risk factor for the development of most T-cell-mediated reactions. Newly emerged genetic and ecological risk factors, combined with HLA-restricted response, align with underlying immunopathogenesis and drive towards enhanced strategies to improve positive-predictive and negative-predictive values. With large population-matched cohorts, genetic studies typically focus on populations that have been readily accessible to research studies, but it is now imperative to address similar risk in globally relevant and understudied populations.
- Published
- 2021
8. Multinational experience with hypersensitivity drug reactions in Latin America
- Author
-
Jares, Edgardo José, Sánchez-Borges, Mario, Cardona-Villa, Ricardo, Ensina, Luis Felipe, Arias-Cruz, Alfredo, Gómez, Maximiliano, Barayazarra, Susana, Bernstein, Jonathan A., Serrano, Carlos D., Cuello, Mabel Noemi, Morfin-Maciel, Blanca María, De Falco, Alicia, and Cherrez-Ojeda, Iván
- Published
- 2014
- Full Text
- View/download PDF
9. Editorial: Advances in hypersensitivity drug reactions
- Author
-
Blanca, Miguel and Whitaker, Paul
- Published
- 2020
- Full Text
- View/download PDF
10. Advances in hypersensitivity drug reactions
- Author
-
Blanca, Miguel and Whitaker, Paul
- Published
- 2018
- Full Text
- View/download PDF
11. Role of pharmacogenomics in T-cell hypersensitivity drug reactions.
- Author
-
Hertzman RJ, Deshpande P, Gibson A, and Phillips EJ
- Subjects
- Aminopeptidases, HLA-B Antigens genetics, Humans, Minor Histocompatibility Antigens, Drug Hypersensitivity diagnosis, Drug Hypersensitivity genetics, Pharmacogenetics, Stevens-Johnson Syndrome, T-Lymphocytes immunology
- Abstract
Purpose of Review: An update of the pharmacogenetic risk factors associated with T-cell-mediated delayed hypersensitivity reactions., Recent Findings: Recent HLA associations relevant to our understanding of immunopathogenesis and clinical practice include HLA-B∗13:01 with co-trimoxazole-induced SCAR, and HLA-A∗32:01 with vancomycin-DRESS, for which an extended HLA class II haplotype is implicated in glycopeptide antibiotic cross-reactivity. Hypoactive variants of ERAP1, an enzyme-trimming peptide prior to HLA loading, are now associated with protection from abacavir-hypersensitivity in HLA-B∗57:01+ patients, and single-cell sequencing has defined the skin-restricted expansion of a single, public and drug-reactive dominant TCR across patients with HLA-B∗15:02-restricted carbamazepine-induced SJS/TEN. More recent strategies for the use of HLA and other risk factors may include risk-stratification, early diagnosis, and diagnosis in addition to screening., Summary: HLA is necessary but insufficient as a risk factor for the development of most T-cell-mediated reactions. Newly emerged genetic and ecological risk factors, combined with HLA-restricted response, align with underlying immunopathogenesis and drive towards enhanced strategies to improve positive-predictive and negative-predictive values. With large population-matched cohorts, genetic studies typically focus on populations that have been readily accessible to research studies, but it is now imperative to address similar risk in globally relevant and understudied populations., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
12. Pharmacogenetics of hypersensitivity drug reactions
- Author
-
Laurent Becquemont and Simone Negrini
- Subjects
0301 basic medicine ,Drug ,Allopurinol ,media_common.quotation_subject ,Abacavir ,Carbamazepine ,HLA ,Hypersensitivity drug reactions ,Human leukocyte antigen ,Drug Hypersensitivity ,03 medical and health sciences ,HLA Antigens ,medicine ,Humans ,Genetic Predisposition to Disease ,Pharmacology (medical) ,Enzyme Inhibitors ,media_common ,business.industry ,Dideoxynucleosides ,030104 developmental biology ,Pharmacogenetics ,Delayed hypersensitivity ,Pharmacogenomics ,Immunology ,Reverse Transcriptase Inhibitors ,Anticonvulsants ,business ,medicine.drug - Abstract
Adverse drug reactions are a significant cause of morbidity and mortality and represent a major burden on the healthcare system. Some of those reactions are immunologically mediated (hypersensitivity reactions) and can be clinically subdivided into two categories: immediate reactions (IgE-related) and delayed reactions (T-cell-mediated). Delayed hypersensitivity reactions include both systemic syndromes and organ-specific toxicities and can be triggered by a wide range of chemically diverse drugs. Recent studies have demonstrated a strong genetic association between human leukocyte antigen alleles and susceptibility to delayed drug hypersensitivity. Most notable examples include human leukocyte antigen (HLA)-B*57:01 allele and abacavir hypersensitivity syndrome or HLA-B*15:02 and HLA-B*58:01 alleles related to severe cutaneous reactions induced by carbamazepine and allopurinol, respectively. This review aims to explore our current understanding in the field of pharmacogenomics of HLA-associated drug hypersensitivities and its translation into clinical practice for predicting adverse drug reactions.
- Published
- 2017
13. Role of pharmacogenomics in T-cell hypersensitivity drug reactions
- Author
-
Pooja Deshpande, Andrew Gibson, Elizabeth J. Phillips, and Rebecca J Hertzman
- Subjects
business.industry ,T cell ,T-Lymphocytes ,Immunology ,Haplotype ,T-cell receptor ,Human leukocyte antigen ,Bioinformatics ,Aminopeptidases ,Article ,Drug Hypersensitivity ,Minor Histocompatibility Antigens ,medicine.anatomical_structure ,Delayed hypersensitivity ,HLA-B Antigens ,Pharmacogenetics ,Pharmacogenomics ,Stevens-Johnson Syndrome ,Immunology and Allergy ,Medicine ,Humans ,Risk factor ,business - Abstract
Purpose of review An update of the pharmacogenetic risk factors associated with T-cell-mediated delayed hypersensitivity reactions. Recent findings Recent HLA associations relevant to our understanding of immunopathogenesis and clinical practice include HLA-B∗13:01 with co-trimoxazole-induced SCAR, and HLA-A∗32:01 with vancomycin-DRESS, for which an extended HLA class II haplotype is implicated in glycopeptide antibiotic cross-reactivity. Hypoactive variants of ERAP1, an enzyme-trimming peptide prior to HLA loading, are now associated with protection from abacavir-hypersensitivity in HLA-B∗57:01+ patients, and single-cell sequencing has defined the skin-restricted expansion of a single, public and drug-reactive dominant TCR across patients with HLA-B∗15:02-restricted carbamazepine-induced SJS/TEN. More recent strategies for the use of HLA and other risk factors may include risk-stratification, early diagnosis, and diagnosis in addition to screening. Summary HLA is necessary but insufficient as a risk factor for the development of most T-cell-mediated reactions. Newly emerged genetic and ecological risk factors, combined with HLA-restricted response, align with underlying immunopathogenesis and drive towards enhanced strategies to improve positive-predictive and negative-predictive values. With large population-matched cohorts, genetic studies typically focus on populations that have been readily accessible to research studies, but it is now imperative to address similar risk in globally relevant and understudied populations.
- Published
- 2021
14. Classification and epidemiology of hypersensitivity drug reactions
- Author
-
Demoly, Pascal and Hillaire-Buys, Dominique
- Published
- 2004
- Full Text
- View/download PDF
15. Allergological evaluation of hypersensitivity drug reactions to betalactams in children
- Author
-
Rojas, Isabel Torres, primary, Prieto-Moreno, Ana, additional, Desamparados Cervera, Maria, additional, Pérez-Alzate, Diana, additional, Javier Ruano, Francisco, additional, Somoza Álvarez, Maria Luisa, additional, López-González, Paula, additional, De La Torre, María Vázquez, additional, Haroun-Díaz, Elisa, additional, Blanca-López, Natalia, additional, and Canto, Gabriela, additional
- Published
- 2021
- Full Text
- View/download PDF
16. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions
- Author
-
Fernandez, T. D., Mayorga, C., Guéant, J. L., Blanca, M., and Cornejo-García, J. A.
- Published
- 2014
- Full Text
- View/download PDF
17. Hypersensitivity drug reactions To Betalactams In Children in a reference Hospital.
- Author
-
Blanca-López, Natalia, primary, Prieto-Moreno Pfeifer, Ana María, additional, Torres-Rojas, Isabel, additional, Alvarez, Maria Somoza, additional, Alzate, Diana Perez, additional, Ruano Pérez, Francisco Javier, additional, Haroun-Diaz, Elisa, additional, Vázquez de La Torre Gaspar, Maria, additional, López-González, Paula, additional, and Diez, Gabriela Canto, additional
- Published
- 2020
- Full Text
- View/download PDF
18. Immediate-type hypersensitivity drug reactions
- Author
-
Stone, Shelley F., Phillips, Elizabeth J., Wiese, Michael D., Heddle, Robert J., and Brown, Simon G. A.
- Published
- 2014
- Full Text
- View/download PDF
19. Immediate-type hypersensitivity drug reactions
- Author
-
Stone, S.F., Phillips, E.J., Wiese, M.D., Heddle, R.J., Brown, S.G.A, Stone, S.F., Phillips, E.J., Wiese, M.D., Heddle, R.J., and Brown, S.G.A
- Abstract
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive.
- Published
- 2014
20. Hypersensitivity Drug Reactions (HDR) In Latin America. Similarities and Differences Between Children and Adults
- Author
-
Cardona Villa, Ricardo, Jares, Edgardo José, Gómez, Maximiliano, Ensina, Luis Felipe C., Sánchez Borges, Mario, Arias Cruz, Alfredo, Serrano, Carlos D., Cuello, Mabel Noemi, Cherrez, Ivan, Zanacchi, Andrea, De Falco, Alicia Mabel, Monsell, Silvana Beatriz, Salvatierra, Adolfo, Barayazarra, Susana, Diez Zuloaga, Susana, Morfín Maciel, Blanca María, Pinaud, Paola Toche, González Díaz, Sandra Nora, Schuhl, Juan F., Cardona Villa, Ricardo, Jares, Edgardo José, Gómez, Maximiliano, Ensina, Luis Felipe C., Sánchez Borges, Mario, Arias Cruz, Alfredo, Serrano, Carlos D., Cuello, Mabel Noemi, Cherrez, Ivan, Zanacchi, Andrea, De Falco, Alicia Mabel, Monsell, Silvana Beatriz, Salvatierra, Adolfo, Barayazarra, Susana, Diez Zuloaga, Susana, Morfín Maciel, Blanca María, Pinaud, Paola Toche, González Díaz, Sandra Nora, and Schuhl, Juan F.
- Published
- 2014
21. Advanced phenotyping in hypersensitivity drug reactions to NSAIDs
- Author
-
Ayuso, P., Blanca-López, N., Doña, I., Torres, M. J., Guéant-Rodríguez, R. M., Canto, G., Sanak, M., Mayorga, C., Guéant, J. L., Blanca, M., and Cornejo-García, J. A.
- Published
- 2013
- Full Text
- View/download PDF
22. Editorial: Advances in hypersensitivity drug reactions
- Author
-
Paul Whitaker and Miguel Blanca
- Subjects
medicine.medical_specialty ,business.industry ,Immunology ,MEDLINE ,Omalizumab ,Immunoglobulin E ,Anti-Bacterial Agents ,Diagnosis, Differential ,Drug Hypersensitivity ,Desensitization, Immunologic ,Anti-Allergic Agents ,Humans ,Immunology and Allergy ,Medicine ,Drug reaction ,business ,Intensive care medicine ,Glucocorticoids ,T-Lymphocytes, Cytotoxic - Published
- 2020
23. Allergological evaluation of hypersensitivity drug reactions to betalactams in children
- Author
-
Paula Lopez-Gonzalez, Elisa Haroun-Díaz, Francisco Javier Ruano, Ana Prieto-Moreno, Maria Vazquez de La Torre, Maria Desamparados Cervera, Isabel Torres Rojas, Natalia Blanca-López, Gabriela Canto, Maria Luisa Somoza Álvarez, and Diana Pérez-Alzate
- Subjects
medicine.medical_specialty ,business.industry ,Immunology ,medicine ,Immunology and Allergy ,Drug reaction ,business ,Dermatology - Published
- 2021
24. Hypersensitivity drug reactions To Betalactams In Children in a reference Hospital
- Author
-
Francisco Javier Ruano Pérez, Gabriela Canto Díez, Elisa Haroun-Díaz, Ana María Prieto-Moreno Pfeifer, Diana Perez Alzate, Natalia Blanca-López, Maria Luisa Somoza Álvarez, Maria Vázquez de La Torre Gaspar, Isabel Torres-Rojas, and Paula Lopez-Gonzalez
- Subjects
medicine.medical_specialty ,business.industry ,Immunology ,medicine ,Immunology and Allergy ,Drug reaction ,business ,Dermatology - Published
- 2020
25. Advances in hypersensitivity drug reactions
- Author
-
Miguel Blanca and Paul Whitaker
- Subjects
Drug Hypersensitivity ,T-Lymphocytes ,Immunology ,Anti-Inflammatory Agents, Non-Steroidal ,Immunology and Allergy ,Humans ,Genetic Predisposition to Disease ,Lymphocyte Activation ,beta-Lactamase Inhibitors - Published
- 2018
26. Phenotypic Expression of Hypersensitivity Drug Reactions in Outpatient Infusion Centers, 1 Year Experience
- Author
-
Falck-Fuentes, Cintia A., primary, Jimenez Rodriguez, Teodorikez W., additional, Lynch, Donna-Marie, additional, Garcia-Neuer, Marlene, additional, Marquis, Kathleen A., additional, Alenazy, Leila A., additional, and Castells, Mariana C., additional
- Published
- 2018
- Full Text
- View/download PDF
27. Multinational experience with hypersensitivity drug reactions in Latin America
- Author
-
Edgardo José, Jares, Mario, Sánchez-Borges, Ricardo, Cardona-Villa, Luis Felipe, Ensina, Alfredo, Arias-Cruz, Maximiliano, Gómez, Susana, Barayazarra, Jonathan A, Bernstein, Carlos D, Serrano, Mabel Noemi, Cuello, Blanca María, Morfin-Maciel, Alicia, De Falco, Iván, Cherrez-Ojeda, and Mario Sánchez- Borges, Caracas
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Allergy ,Pediatrics ,medicine.medical_specialty ,Latin Americans ,Adolescent ,Cross-sectional study ,Immunology ,Drug allergy ,Severity of Illness Index ,Drug Hypersensitivity ,Young Adult ,Severity of illness ,Hypersensitivity ,medicine ,Humans ,Immunology and Allergy ,Young adult ,Child ,Aged ,Aged, 80 and over ,business.industry ,Infant ,Emergency department ,Middle Aged ,medicine.disease ,Cross-Sectional Studies ,Latin America ,Child, Preschool ,Female ,business ,Anaphylaxis - Abstract
Epidemiologic drug allergy data from Latin America are scarce, and there are no studies on specific procedures focusing on this topic in Latin America.To assess the clinical characteristics and management of hypersensitivity drug reactions in different Latin American countries.An European Network of Drug Allergy questionnaire survey was implemented in 22 allergy units in 11 Latin American countries to report on consecutive patients who presented with a suspected hypersensitivity drug reaction. Each unit used its own protocols to investigate patients.Included were 868 hypersensitivity drug reactions in 862 patients (71% of adults and elderly patients were women and 51% of children were girls, P = .0001). Children presented with less severe reactions than adults and elderly patients (P.0001). Urticaria and angioedema accounted for the most frequent clinical presentations (71%), whereas anaphylaxis was present in 27.3% of cases. There were no deaths reported. Nonsteroidal anti-inflammatory drugs (52.3%), β-lactam antibiotics (13.8%), and other antibiotics (10.1%) were the drugs used most frequently. Skin prick tests (16.7%) and provocation tests (34.2%) were the study procedures most commonly used. A large proportion of patients were treated in the emergency department (62%) with antihistamines (68%) and/or corticosteroids (53%). Only 22.8% of patients presenting with anaphylaxis received epinephrine.Nonsteroidal anti-inflammatory drugs and antibiotics were the drugs used in at least 75% of patients. More than half the reactions were treated in the emergency department, whereas epinephrine was administered in fewer than 25% of patients with anaphylaxis. Dissemination of guidelines for anaphylaxis among primary and emergency department physicians should be encouraged.
- Published
- 2014
28. Carbamazepine-Induced Anticonvulsant Hypersensitivity Syndrome: Pathogenic and Diagnostic Considerations: Epicutaneous Test in Carbamazepine Cutaneous Reactions: Delayed Hypersensitivity Drug Reactions Diagnosed by Patch Testing
- Author
-
Rothe, Marti Jill
- Published
- 1994
29. Immediate-type hypersensitivity drug reactions
- Author
-
Robert J. Heddle, Shelley F. Stone, Michael D. Wiese, Elizabeth J. Phillips, and Simon G A Brown
- Subjects
Pharmacology ,Drug ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,medicine.medical_treatment ,Provocation test ,Drug allergy ,medicine.disease ,Hypersensitivity reaction ,Immune system ,Immunology ,Medicine ,Pharmacology (medical) ,business ,Intensive care medicine ,Adverse drug reaction ,Anaphylaxis ,media_common ,Desensitization (medicine) - Abstract
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive.
- Published
- 2014
30. Advances in hypersensitivity drug reactions.
- Author
-
Blanca M and Thong BY
- Subjects
- Humans, Drug Hypersensitivity, Drug-Related Side Effects and Adverse Reactions
- Published
- 2016
- Full Text
- View/download PDF
31. Reações Cutâneas de Hipersensibilidade Retardada a Medicamentos: Serão os Testes Epicutâneos Positivos Persistentes?
- Author
-
Pinho, André, Santiago, Luís, and Gonçalo, Margarida
- Abstract
Introduction: Like in allergic contact dermatitis, in non-immediate (NI) cutaneous adverse drug reactions (CADR) delayed hypersensitivity to antibiotics and anticonvulsants is considered to be lifelong. Although in allergic contact dermatitis patch tests remain positive for several years, this has seldom been assessed in the setting of NI-CADR to systemic drugs. Objective: To evaluate the long term behaviour of positive patch test reactions in NI-CADR to beta-lactams, clindamycin and carbamazepine. Methods: The drugs associated with the largest number of positive patch test reactions (beta-lactams, clindamycin and carbamazepin) were selected and 64 patients with history of NI-CADR to these drugs and relevant positive reactions were invited to repeat patch tests, at least 2 years thereafter. New patch test reactions were compared with the original ones. Results: In the 23 patients included in the study (10 males/ 13 females, median age 51 years) there were 44 positive reactions at the first patch tests and 40 (91.1%) of these remained positive after a median interval of 6.5 years (min. 2.0 - max. 30.7 years). Concerning beta-lactams, 17/19 reactions persisted positive for aminopenicillins (amoxicillin or ampicillin), 8/8 for isoxazolyl penicillins (flucloxacillin or dicloxacillin), 3/3 for benzylpenicillin, 1/1 for cefoxitin and 1/1 with piperacillin. Reactions with clindamycin remained positive in 5/7 cases. All five patch tests repeated with carbamazepine were positive. In 62.5% of the tests the same intensity of reaction was observed and was not affected by the time interval between tests, gender or age at performing patch tests. Conclusion: In NI-CADR to several antibiotics and carbamazepine, most of the patch test reactions remained positive after several years. [ABSTRACT FROM AUTHOR]
- Published
- 2017
- Full Text
- View/download PDF
32. Advances in hypersensitivity drug reactions
- Author
-
Miguel Blanca and Bernard Yu-Hor Thong
- Subjects
030201 allergy ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,business.industry ,Immunology ,MEDLINE ,Drug Hypersensitivity ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,medicine ,Immunology and Allergy ,Humans ,Drug reaction ,Intensive care medicine ,business ,Introductory Journal Article - Published
- 2016
33. Progress in understanding hypersensitivity drug reactions
- Author
-
Miguel Blanca and Bernard Yu-Hor Thong
- Subjects
Drug Hypersensitivity ,Immunity, Cellular ,medicine.medical_specialty ,business.industry ,T-Lymphocytes ,Immunology ,medicine ,Humans ,Immunology and Allergy ,Drug reaction ,Immunoglobulin E ,Intensive care medicine ,business - Published
- 2012
34. Drug provocation tests in hypersensitivity drug reactions
- Author
-
Ticha Rerkpattanapipat, Anca-Mirela Chiriac, and Pascal Demoly
- Subjects
Drug ,medicine.medical_specialty ,Drug-Related Side Effects and Adverse Reactions ,medicine.medical_treatment ,media_common.quotation_subject ,Immunology ,Provocation test ,Dose-Response Relationship, Immunologic ,Contrast Media ,beta-Lactams ,Sensitivity and Specificity ,Drug Hypersensitivity ,Beta-lactam ,chemistry.chemical_compound ,Diagnostic Uses of Chemicals ,Predictive Value of Tests ,Triiodobenzoic Acids ,medicine ,Humans ,Immunology and Allergy ,Drug reaction ,Anesthetics, Local ,Glucocorticoids ,Skin Tests ,Desensitization (medicine) ,media_common ,Aspirin ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Dermatology ,Pharmaceutical Preparations ,chemistry ,Desensitization, Immunologic ,Decreased Sensitivity ,Predictive value of tests ,Drug Eruptions ,business ,medicine.drug - Abstract
Drug provocation test (DPT) is necessary to diagnose most drug hypersensitivity reactions (HSRs) due to decreased sensitivity of skin testing even when combined with in-vitro tests in immunonologic drug HSR and limited availability of these tests in nonimmunologic reaction. We review the principles and controversial issues of DPT, and recent studies using DPT as a diagnostic tool.DPT is recommended in the diagnosis of HSR to β-lactams, as well as other drug classes [such as acetylsalicylic acid-NSAIDs (ASA-NSAIDs), non-β-lactams antibiotics, heparin, glucocorticoids, and local anesthetic agents]. In view of the decreased sensitivity of skin testing, limited accessibility to new benzylpenicillin polylysine (PPL)/mixture of minor determinant (MDM) test reagents and limited availability of validated sensitive in-vitro tests, individuals who require DPT to β-lactams are increasing. The negative predictive value of allergologic work-up is very high, ranging from 94 to 98% for β-lactams and those reactions after negative tests are mostly nonimmediate and mild. Finally, DPT is recommended to ascertain tolerability of alternative compound when evaluating cross-reactivity among different classes of β-lactams, NSAIDs and glucocorticoids, and possibly iodinated contrast media.DPT is often needed when evaluating patients with suspected drug HSR. More studies regarding standardization of the various protocols are needed in order to increase its acceptance and adoption as a standard practice in the diagnostic algorithm for drug HSR.
- Published
- 2011
35. Phenotypic Expression of Hypersensitivity Drug Reactions in Outpatient Infusion Centers, 1 Year Experience
- Author
-
Kathleen A. Marquis, Donna-Marie Lynch, Marlene Garcia-Neuer, Cintia A. Falck-Fuentes, Leila A. Alenazy, Teodorikez W. Jimenez Rodriguez, and Mariana Castells
- Subjects
Expression (architecture) ,business.industry ,Immunology ,Immunology and Allergy ,Medicine ,Drug reaction ,business ,Phenotype - Published
- 2018
36. Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity
- Author
-
Blanca-Lopez N, Blanca M, Canto G, Mayorga C, Tahia Diana Fernandez, Barrionuevo E, Mj, Torres, and Doña I
- Subjects
Drug Hypersensitivity ,Biological Factors ,T-Lymphocytes ,Contrast Media ,Humans ,Immunoglobulin E ,Neuromuscular Blocking Agents ,Anti-Bacterial Agents - Abstract
Hypersensitivity drug reactions (HDRs) vary over time in frequency, drugs involved, and clinical entities. Specific reactions are mediated by IgE, other antibody isotypes (IgG or IgM), and T cells. Nonspecific HDRs include those caused by nonsteroidal anti-inflammatory drugs (NSAIDs). beta-Lactams--the most important of which are amoxicillin and clavulanic acid--are involved in specific immunological mechanisms. Fluoroquinolones (mainly moxifloxacin, followed by ciprofloxacin and levofloxacin) can also induce HDRs mediated by IgE and T cells. In the case of radio contrast media, immediate reactions have decreased, while nonimmediate reactions, mediated by T cells, have increased. There has been a substantial rise in hypersensitivity reactions to antibiotics and latex in perioperative allergic reactions to anesthetics. NSAIDs are the most frequent drugs involved in HDRs. Five well-defined clinical entities, the most common of which is NSAID-induced urticaria/angioedema, have been proposed in a new consensus classification. Biological agents are proteins including antibodies that have been humanized in order to avoid adverse reactions. Reactions can be mediated by IgE or T cells or they may be due to an immunological imbalance. Chimeric antibodies are still in use and may have epitopes that are recognized by the immune system, resulting in allergic reactions.
- Published
- 2014
37. Classification and epidemiology of hypersensitivity drug reactions
- Author
-
Pascal Demoly and Dominique Hillaire-Buys
- Subjects
Drug ,medicine.medical_specialty ,business.industry ,Incidence ,Incidence (epidemiology) ,media_common.quotation_subject ,Immunology ,MEDLINE ,Health Care Costs ,Dermatology ,Drug Hypersensitivity ,Hospitalization ,Risk Factors ,Immunopathology ,Epidemiology ,Prevalence ,medicine ,Humans ,Immunology and Allergy ,Drug reaction ,Epidemiologic data ,business ,media_common - Abstract
Nonimmune hypersensitivity reactions are unpredictable adverse drug reactions that are clinically similar to allergic reactions for which no drug-specific antibodies or T lymphocytes are identified. Few tools allow a definite diagnosis, and most of the available ones need to be validated. True epidemiologic data are limited, and most of the available information on the incidence, mortality, and socioeconomic impact should be discussed with caution.
- Published
- 2004
38. Hypersensitivity drug reactions.
- Author
-
Thong BY and Blanca M
- Subjects
- Humans, Drug Hypersensitivity
- Published
- 2014
- Full Text
- View/download PDF
39. NSAIDs are the most frequent medicaments involved in hypersensitivity drug reactions.
- Author
-
Doña I, Blanca-Lopez N, and Cornejo-Garcia JA
- Subjects
- Female, Humans, Anti-Inflammatory Agents, Non-Steroidal adverse effects, Cyclooxygenase 2 Inhibitors adverse effects, Drug Hypersensitivity etiology, Urticaria chemically induced
- Published
- 2014
40. Trends in hypersensitivity drug reactions: more drugs, more response patterns, more heterogeneity.
- Author
-
Doña I, Barrionuevo E, Blanca-Lopez N, Torres MJ, Fernandez TD, Mayorga C, Canto G, and Blanca M
- Subjects
- Anti-Bacterial Agents adverse effects, Biological Factors adverse effects, Contrast Media adverse effects, Humans, Immunoglobulin E immunology, Neuromuscular Blocking Agents adverse effects, T-Lymphocytes immunology, Drug Hypersensitivity etiology
- Abstract
Hypersensitivity drug reactions (HDRs) vary over time in frequency, drugs involved, and clinical entities. Specific reactions are mediated by IgE, other antibody isotypes (IgG or IgM), and T cells. Nonspecific HDRs include those caused by nonsteroidal anti-inflammatory drugs (NSAIDs). beta-Lactams--the most important of which are amoxicillin and clavulanic acid--are involved in specific immunological mechanisms. Fluoroquinolones (mainly moxifloxacin, followed by ciprofloxacin and levofloxacin) can also induce HDRs mediated by IgE and T cells. In the case of radio contrast media, immediate reactions have decreased, while nonimmediate reactions, mediated by T cells, have increased. There has been a substantial rise in hypersensitivity reactions to antibiotics and latex in perioperative allergic reactions to anesthetics. NSAIDs are the most frequent drugs involved in HDRs. Five well-defined clinical entities, the most common of which is NSAID-induced urticaria/angioedema, have been proposed in a new consensus classification. Biological agents are proteins including antibodies that have been humanized in order to avoid adverse reactions. Reactions can be mediated by IgE or T cells or they may be due to an immunological imbalance. Chimeric antibodies are still in use and may have epitopes that are recognized by the immune system, resulting in allergic reactions.
- Published
- 2014
41. Immediate-type hypersensitivity drug reactions
- Author
-
Stone, Shelley F, Phillips, Elizabeth J, Wiese, Michael David, Heddle, Robert J, and Brown, Simon GA
- Subjects
adverse drug reaction ,anaphylaxis ,immediate-type ,IgE-mediated - Abstract
Hypersensitivity reactions including anaphylaxis have been reported for nearly all classes of therapeutic reagents and these reactions can occur within minutes to hours of exposure. These reactions are unpredictable, not directly related to dose or the pharmacological action of the drug and have a relatively high mortality risk. This review will focus on the clinical presentation, immune mechanisms, diagnosis and prevention of the most serious form of immediate onset drug hypersensitivity reaction, anaphylaxis. The incidence of drug-induced anaphylaxis deaths appears to be increasing and our understanding of the multiple and complex reasons for the unpredictable nature of anaphylaxis to drugs is also expanding. This review highlights the importance of enhancing our understanding of the biology of the patient (i.e. immune response, genetics) as well as the pharmacology and chemistry of the drug when investigating, diagnosing and treating drug hypersensitivity. Misdiagnosis of drug hypersensitivity leads to substantial patient risk and cost. Although oral provocation is often considered the gold standard of diagnosis, it can pose a potential risk to the patient. There is an urgent need to improve and standardize diagnostic testing and desensitization protocols as other diagnostic tests currently available for assessment of immediate drug allergy are not highly predictive. Refereed/Peer-reviewed
- Published
- 2014
42. Contributions of pharmacogenetics and transcriptomics to the understanding of the hypersensitivity drug reactions
- Author
-
Cristobalina Mayorga, Tahia D. Fernandez, Jose A. Cornejo-Garcia, M. Blanca, Jean-Louis Guéant, Biomedical Research Institute of Málaga (IBIMA), Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)
- Subjects
0303 health sciences ,[SDV]Life Sciences [q-bio] ,Gene Expression Profiling ,Immunology ,Drug allergy ,Biology ,Bioinformatics ,medicine.disease ,3. Good health ,Transcriptome ,Drug Hypersensitivity ,03 medical and health sciences ,transcriptomics ,0302 clinical medicine ,030228 respiratory system ,Pharmacogenetics ,medicine ,Immunology and Allergy ,Humans ,Identification (biology) ,Drug reaction ,drug allergy ,030304 developmental biology - Abstract
Hypersensitivity drug reactions (HDRs) represent a large and important health problem, affecting many patients and leading to a variety of clinical entities, some of which can be life-threatening. The culprit drugs include commonly used medications including antibiotics and NSAIDs. Nontherapeutical agents, such as contrast media, are also involved. Because the pathophysiological mechanisms are not well known and the current diagnostic procedures are somewhat insufficient, new approaches are needed for understanding the complexity of HDRs. Histochemical and molecular biology studies have enabled us to classify these reactions more precisely. Pharmacogenetics has led to the identification of several genes, involved mainly in T-cell-dependent responses, with a number of markers being replicated in different studies. These markers are now being considered as potential targets for reducing the number of HDRs. Transcriptomic approaches have also been used to investigate HDRs by identifying genes that show different patterns of expression in a number of clinical entities. This information can be of value for further elucidation of the mechanisms involved. Although first studies were performed using RT-PCR analysis to monitor the acute phase of the reaction, nowadays high-density expression platforms represent a more integrative way for providing a complete view of gene expression. By combining a detailed and precise clinical description with information obtained by these approaches, we will obtain a better understanding and management of patients with HDRs.
- Published
- 2013
43. Advanced phenotyping in hypersensitivity drug reactions to NSAIDs
- Author
-
Pedro Ayuso, Natalia Blanca-López, M.J. Torres, Jose A. Cornejo-Garcia, Gabriela Canto, Inmaculada Doña, Cristobalina Mayorga, Marek Sanak, Rosa-Maria Guéant-Rodriguez, Jean-Louis Guéant, Miguel Blanca, Allergy Service [Carlos Haya Hospital], Hospital Regional Universitario Carlos Haya, Allergy Service [Hospital Universitario Infanta Leonor], Hospital Universitario Infanta Leonor [Madrid], Nutrition-Génétique et Exposition aux Risques Environnementaux (NGERE), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), and Jagiellonian University School of Medicine
- Subjects
[SDV]Life Sciences [q-bio] ,Immunology ,Disease ,Drug Hypersensitivity ,03 medical and health sciences ,0302 clinical medicine ,Immunology and Allergy ,Medicine ,Humans ,Drug reaction ,skin and connective tissue diseases ,030304 developmental biology ,0303 health sciences ,Acute urticaria ,Angioedema ,business.industry ,Respiratory disease ,Anti-Inflammatory Agents, Non-Steroidal ,medicine.disease ,digestive system diseases ,3. Good health ,Phenotype ,030228 respiratory system ,medicine.symptom ,business ,Pharmacogenetics - Abstract
International audience; Non-steroidal anti-inflammatory drugs (NSAIDs) are the medications most frequently involved in hypersensitivity drug reactions. Because NSAIDs are prescribed for many conditions, this is a world-wide problem affecting patients of all ages. Various hypersensitivity reactions have been reported, mainly affecting the skin and/or the respiratory airways. The most frequent of these is acute urticaria, which can be induced by several different NSAIDs. Both specific and non-specific immunological pathways have been proposed as underlying mechanisms. This review presents the clinical phenotypes and the drugs involved in NSAID hypersensitivity. Five major clinical syndromes can be distinguished: aspirin-exacerbated respiratory disease (AERD), aspirin-exacerbated cutaneous disease (AECD), multiple NSAID-induced urticaria/angioedema (MNSAID-UA), single NSAID-IgE reactions and single NSAID T cell responses. However, further classification is possible within these five major entities, by detailed descriptions of the clinical characteristics enabling more phenotypes to be defined. This detailed differentiation now seems required in order to undertake appropriate pharmacogenetic studies.
- Published
- 2013
44. Une synthèse sur l'épidémiologie des hypersensibilités médicamenteuses
- Author
-
Bousquet, P.-J. and Demoly, P.
- Subjects
- *
DRUG side effects , *PUBLIC health , *MEDICAL care costs , *HOSPITAL care - Abstract
Abstract: Hypersensitivity reactions are but one of many different types of adverse drug reactions. Reactions of this type may be potentially lifethreatening, induce and prolong hospitalization, affect physicians'' drug prescribing patterns and result in considerable socioeconomic costs. Welldesigned epidemiological studies limited to allergic drug reactions are lacking; most of the studies related to this problem have included all types of adverse drug reactions. The results of such studies should help us to identify patients at risk, particularly those at risk for severe reactions, and allow us to implement preventive measures. This review will summarize current knowledge on the incidence, prevalence, mortality and risk factors for hypersensitivity drug reactions. [Copyright &y& Elsevier]
- Published
- 2005
- Full Text
- View/download PDF
45. NSAID-induced reactions: classification, prevalence, impact, and management strategies
- Author
-
Blanca-Lopez N, Soriano V, Garcia-Martin E, Canto G, and Blanca M
- Subjects
NSAIDs ,Hypersensitivity drug reactions ,mechanisms ,management ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Natalia Blanca-Lopez,1 Victor Soriano,2 Elena Garcia-Martin,3 Gabriela Canto,1 Miguel Blanca11Infanta Leonor University Hospital, Madrid, Spain; 2General University Hospital of Alicante-ISABIAL, Alicante, Madrid, Spain; 3Medical and Surgery Therapy Department, University of Extremadura, Caceres, SpainAbstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are the leading cause of hypersensitivity drug reactions. The different chemical structures, cyclooxygenase 1 (COX-1) and/or COX-2 inhibitors, are taken at all ages and some can be easily obtained over the counter. Vasoactive inflammatory mediators like histamine and leukotriene metabolites can produce local/systemic effects. Responders can be selective (SR), IgE or T-cell mediated, or cross-intolerant (CI). Inhibition of the COX pathway is the common mechanism in CI, with the skin being the most frequent organ involved, followed by the lung and/or the nose. An important number of cases have skin and respiratory involvement, with systemic manifestations ranging from mild to severe anaphylaxis. Among SR, this is the most frequent entity, often being severe. Recent years have seen an increase in reactions involving the skin, with many cases having urticaria and/or angioedema in the absence of chronic urticaria. Aspirin, the classical drug involved, has now been replaced by other NSAIDs, with ibuprofen being the universal culprit. For CI, no in vivo/in vitro diagnostic methods exist and controlled administration is the only option unless the cases evaluated report repetitive and consistent episodes with different NSAIDs. In SR, skin testing (patch and intradermal) with 24–48 reading can be useful, mainly for delayed T-cell responses. Acetyl salicylic acid (ASA) is the test drug to establish the diagnosis and confirm/exclude CI by controlled administration. Desensitization to ASA has been extensively used in respiratory cases though it can also be applied in those cases where it is required.Keywords: NSAIDs, hypersensitivity drug reactions, mechanisms, management
- Published
- 2019
46. Progress in the understanding of hypersensitivity drug reactions.
- Author
-
Blanca M and Thong BY
- Subjects
- Animals, Humans, Drug Hypersensitivity Syndrome immunology, Drug Hypersensitivity Syndrome pathology, Drug Hypersensitivity Syndrome physiopathology, Drug Hypersensitivity Syndrome therapy, Immunoglobulin E immunology, Stevens-Johnson Syndrome immunology, Stevens-Johnson Syndrome pathology, Stevens-Johnson Syndrome physiopathology, Stevens-Johnson Syndrome therapy, T-Lymphocytes immunology
- Published
- 2013
- Full Text
- View/download PDF
47. Hypersensitivity Drug Reactions
- Full Text
- View/download PDF
48. Hypersensitivity drug reactions
- Author
-
Miguel Blanca and Bernard Yu-Hor Thong
- Subjects
Drug ,medicine.medical_specialty ,Allergy ,Clinical immunology ,business.industry ,media_common.quotation_subject ,Immunology ,medicine.disease ,Dermatology ,Expert group ,Drug Hypersensitivity ,medicine ,Humans ,Immunology and Allergy ,Drug reaction ,business ,Asthma ,media_common - Abstract
In this new issue of Current Opinion in Allergy and Clinical Immunology, five major areas of research in the field of hypersensitivity reactions to drugs in the past year are reviewed. The manuscript of Blanca-Lopez et al.[1] is devoted to hypersensitivity reactions to NSAIDs. NSAIDs are the drugs most frequently involved in hypersensitivity drug reactions [2,3]. In a study published recently, it has been shown that almost 50% of the cases had confirmed NSAIDs hypersensitivity followed by 20% with beta-lactam hypersensitivity. Both groups of drugs together contributed to more than the 70% of drug hypersensitivity reactions [2]. These results are consistent with data published by other groups [3]. There has been increasing interest in the nonpulmonary manifestations of NSAID hypersensitivity, which have not been studied in detail. An expert group from the European Academy of Allergy Asthma and Clinical Immunology has provided a consensus document, carefully defining these reactions [4]. Five major clinical entities are now recognized, and it is expected that in the future major subgroups will be identified making genome-wide association studies more specific to each clinical entity [5–7].
- Published
- 2014
49. Involvement of the activating receptor NKG2D in cutaneous hypersensitivity drug reactions
- Author
-
Bellón, Teresa, primary, García, Marcial, additional, Pardo, Elena, additional, Escamochero, Salvador, additional, Fiandor, Ana María, additional, Herranz, Pedro, additional, Cabañas, Rosario, additional, and González‐Herrada, Carlos, additional
- Published
- 2014
- Full Text
- View/download PDF
50. Hypersensitivity Drug Reactions (HDR) In Latin America. Similarities and Differences Between Children and Adults
- Author
-
Cardona-Villa, Ricardo, primary, Jares, Edgardo J., additional, Gómez, Maximiliano, additional, Ensina, Luis Felipe C., additional, Sánchez-Borges, Mario, additional, Cruz, Alfredo Arias, additional, Serrano, Carlos, additional, Cuello, Mabel Noemi, additional, Cherrez, Ivan, additional, Zanacchi, Andrea, additional, De Falco, Alicia, additional, Monsell, Silvana, additional, Salvatierra, Adolfo, additional, Barayazarra, Susana, additional, Diez-Zuloaga, Susana, additional, Morfin-Maciel, Blanca Maria, additional, Pinaud, Paola Toche, additional, Díaz, Sandra González, additional, and Schuhl, Juan F., additional
- Published
- 2014
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.