cardiovascular-agents and Urticaria

Severe anaphylaxis in Hymenoptera venom allergy has been associated with a number of risk factors including elevation of baseline serum tryptase (BST), older age, concomitant diseases, and concurrent medication.. The aim of this study was to evaluate indicators and risk factors for severe anaphylaxis due to Hymenoptera field stings with an emphasis on details related to the sting reaction and concurrent medication.. In this single-center observational cohort study, we included 657 consecutive patients fulfilling the criteria for venom immunotherapy. Severity of sting-induced anaphylaxis was analyzed in relation to patient-specific risk factors (age and sex, preexisting cardiopulmonary conditions, cardiovascular medication) and details related to the sting reaction (culprit insect, localization of the sting, time interval to onset of symptoms, and presence or absence of cutaneous involvement). BST was determined in a subgroup of patients with moderate to severe anaphylaxis.. Four significant indicators and risk factors of severe anaphylaxis were identified (P < .001): (1) elevation of BST, (2) absence of urticaria or angioedema during anaphylaxis, (3) time interval of less than 5 minutes from sting to onset of symptoms, and (4) senior age. The absence of urticaria/angioedema is significantly related to BST elevation (P = .02). No relationship could be established between the severity of anaphylaxis and comorbidities or concurrent cardiovascular medication.. Absence of urticaria/angioedema is an indicator of severe anaphylaxis and possibly mastocytosis, requiring determination of BST. Study data do not provide evidence for an aggravation of sting-induced anaphylaxis by concurrent beta-blockade or angiotensin-converting enzyme inhibition.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anaphylaxis; Angioedema; Animals; Arthropod Venoms; Cardiovascular Agents; Child; Cohort Studies; Female; Humans; Hymenoptera; Insect Bites and Stings; Male; Middle Aged; Reaction Time; Risk Factors; Time Factors; Tryptases; Urticaria

(1) Photosensitivity reactions are cutaneous disorders due to exposure to ultraviolet (UV) radiation of natural or artificial origin. They occur or are more prevalent on unprotected skin. The main clinical manifestations are burns, eczema-like rash, urticaria, pigmentation, or onycholysis; (2) Many drugs increase cutaneous sensitivity to UV, sometimes for therapeutic purposes, but it is generally an unwanted effect.

Topics: Aminolevulinic Acid; Amiodarone; Anti-Arrhythmia Agents; Anti-Inflammatory Agents, Non-Steroidal; Cardiovascular Agents; Dermatitis, Photoallergic; Dermatitis, Phototoxic; Dihematoporphyrin Ether; Diuretics; Doxycycline; Drug Hypersensitivity; Drug-Related Side Effects and Adverse Reactions; Eczema; Furocoumarins; Hematoporphyrin Photoradiation; Humans; Methotrexate; Onycholysis; Photochemotherapy; Photosensitivity Disorders; Photosensitizing Agents; Porphyrins; Psychotropic Drugs; Quinolines; Skin; Skin Aging; Skin Diseases; Skin Neoplasms; Skin Pigmentation; Sulfonamides; Sunscreening Agents; Tetracycline; Ultraviolet Rays; Urticaria; Verteporfin

Suspected drug hypersensitivity is common. Only a minority of cutaneous adverse drug reactions (CADRs) are allergic in origin and will reappear after the next exposure. Methods to confirm suspected CADRs are needed and skin testing could serve as one possibility.. To analyse the usefulness of skin tests in revealing drug allergy. The relevance of skin test results was evaluated with drug provocation studies.. During 1989-2001, 947 patients with a history of suspected CADR were examined with skin tests including patch tests (PTs) (826 patients), skin prick tests (SPTs) (935 patients) and photopatch tests (12 patients). The occurrence of positive and negative test reactions to different drugs was correlated with clinical history. Drug provocation was carried out in 246 patients.. Antimicrobial drugs were suspected and tested most often. A positive PT reaction to one or more drug was seen in 89 of 826 (10.8%), most often to beta-lactams, clindamycin and trimethoprim. A positive SPT reaction was seen in 10 of 935 (1.1%) patients. Challenge was carried out in 17 patients with positive skin test results. Thirteen of 16 (81.2%) PT positives developed exanthema, three remained negative and one SPT-positive patient developed urticaria. Among skin test negatives, 207 of 229 (90.4%) challenges were negative and 22 of 229 (9.6%) were positive, 12 with exanthema, three with fixed drug eruptions and seven with urticaria.. Skin testing, especially the PT, was a useful screening method to find a cause of CADR if the reaction was exanthema and if antimicrobial, cardiovascular or antiepileptic drugs were suspected. The SPT detected occasional positives with antimicrobials. In cases of fixed drug eruption, PTs performed at the earlier reaction site were useful. When skin tests are negative or dubious, oral challenge should be carried out to confirm the association.

Topics: Anti-Infective Agents; Anticonvulsants; Cardiovascular Agents; Drug Eruptions; Exanthema; Humans; Intradermal Tests; Patch Tests; Skin Tests; Urticaria

Topics: Cardiovascular Agents; Dihydroergotamine; Ergot Alkaloids; Humans; Oxytocics; Urticaria