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Hypersensitivity Reaction

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161. Hypersensitivity Events, Including Potentially Hypersensitivity-Related Skin Events, with Dapagliflozin in Patients with Type 2 Diabetes Mellitus: A Pooled Analysis.

, hypersensitivity AEs were slightly more frequent with dapagliflozin than with placebo across the overall population (4.7 vs. 3.8 %), and less frequent with dapagliflozin in Asian patients (1.5 vs. 5.0 %).The findings of this post hoc analysis indicate that dapagliflozin does not lead to an increased risk of serious hypersensitivity reactions or potentially hypersensitivity-related skin events among patients with T2DM, including Asian patients. Long-term outcome studies and postmarketing surveillance (...) will provide further information on hypersensitivity reactions with SGLT2 inhibitors. CLINICALTRIALS.NCT01042977, NCT01031680, NCT00855166, NCT00984867, NCT01294423, NCT00673231, NCT00972244, NCT00680745, NCT00660907, NCT01095653, NCT00831779, NCT00976495, NCT00859898, NCT00736879, NCT00683878, NCT00663260, NCT00643851, NCT00528879, NCT00528372, NCT00357370, NCT00263276.

2018 Clinical drug investigation

162. Common cutaneous drug reactions

and angio-oedema; and the spectrum of skin lesions including fixed drug eruptions, erythema multiforme, DRESS (drug reaction with eosinophilia and systemic symptoms; also called drug hypersensitivity syndrome), Stevens-Johnson syndrome, and toxic epidermal necrolysis. Together these account for the majority of all drug-induced skin manifestations. Any drug can cause a predictable or unpredictable reaction; those commonly implicated include beta-lactam antibiotics, muscle relaxants used in anaesthesia (...) drug eruptions typically present as pruritus, maculopapular eruptions, urticaria, angio-oedema, phototoxic and photoallergic reactions, fixed drug reactions, vesiculobullous reactions, and exfoliative lesions. These manifestations clinically resemble an allergic response and are considered drug hypersensitivity reactions (DHRs). Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician's guide to terminology, documentation, and reporting. Ann Intern Med. 2004 May 18;140(10):795

2018 BMJ Best Practice

163. Pharmacogenetic testing to identify the risk of adverse reactions to anti-epileptic medications.

was this topic appraised? Some antiepileptic medications can induce serious hypersensitivity reactions. These reactions are rare, but severe. Genetic markers have been associated with these adverse reactions, in particular HLA alleles. Using genetic testing for these markers before starting treatment could identify people who are most at risk of a reaction and may benefit from an alternative treatment choice. Topic Exploration Report TER017 (01.2019) TER Evidence Appraisal Review EAR010 (09.2019) EAR Access (...) Pharmacogenetic testing to identify the risk of adverse reactions to anti-epileptic medications. Pharmacogenetic testing - Health Technology Wales > Pharmacogenetic testing Pharmacogenetic testing Topic Status Complete Pharmacogenetic testing to identify the risk of adverse reactions to anti-epileptic medications. Outcome The evidence on the use of pharmacogenetics testing to identify the risk of adverse reactions to anti-epileptic medications is limited. Some evidence was identified on the use

2019 Health Technology Wales

164. Guidelines on the Perioperative Management of Patients with Suspected or Proven Hypersensitivity to Chlorhexidine

as “chlorhexidine allergic” in the absence of prior allergy testing. Referral to an appropriate testing centre for investigation of potential chlorhexidine hypersensitivity should occur as soon as reasonably practicable. 3.3 Patients with a history suggestive of perioperative anaphylaxis which has not been investigated, particularly where the reaction was delayed in relation to induction of anaesthesia or intravenous drug administration, may have chlorhexidine hypersensitivity. If a surgical procedure (...) OF EXPOSURE IN ALLERGIC PATIENTS 5.1 As with hypersensitivity to any drug or substance, the key to avoiding further reactions is the avoidance of exposure. The increasingly widespread presence of chlorhexidine in clinical environments and the lack of clear labelling of its presence in many products mandates adoption of additional precautions. 5.2 Patients should be allocated single rooms. All products containing chlorhexidine (including hand rubs and chlorhexidine containing skin wipes) must be removed

2016 Australian and New Zealand College of Anaesthetists

165. Guidelines on the Perioperative Management of Patients with Suspected or Proven Hypersensitivity to Chlorhexidine Background Paper

is to prevent recurrent inadvertent exposure and subsequent hypersensitivity reaction in these patients. The ANZCA Anaesthetic Allergy Subcommittee was convened in 2012 and works closely with the Australian and New Zealand Anaesthetic Allergy Group (ANZAAG). The subcommittee identified that as chlorhexidine was a very common hidden agent in the theatre environment and it has an increasing frequency of induced anaphylaxis, it warranted a policy in its own right. PS60 has been developed as ‘Guidelines (...) it appears that the incidence of anaphylaxis to chlorhexidine is low (due to the increasing denominator episodes of exposure), the numbers of patients experiencing adverse reactions appear to be increasing 6 . Many case reports and case series of chlorhexidine anaphylaxis are described in the literature 7-50 . A governmental warning was issued in Japan in 1984, prohibiting the use of chlorhexidine on mucosal membranes 8 . Warnings specific to hypersensitivity reactions from chlorhexidine impregnated

2016 Australian and New Zealand College of Anaesthetists

166. NovaMin (Calcium Sodium Phosphosilicate) Dentifrices Reduce Dentinal Hypersensitivity More Than Potassium Nitrate Dentifrices

potassium nitrate dentrifices, which might deter some patients. Another downfall to NovaMin would be a possible allergic reaction to the active ingredients. However, NovaMin seems to be a safe and effective option for patients suffering from dentinal hypersensitivity. Patients should be informed that NovaMin has been shown to provide relief that is superior to potassium nitrate in the short run; however, the difference between the two products diminishes the longer the patient uses the product (...) NovaMin (Calcium Sodium Phosphosilicate) Dentifrices Reduce Dentinal Hypersensitivity More Than Potassium Nitrate Dentifrices UTCAT3059, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title NovaMin (Calcium Sodium Phosphosilicate) Dentifrices Reduce Dentinal Hypersensitivity More Than Potassium Nitrate Dentifrices Clinical Question In healthy adult patients, do NovaMin dentifrices reduce symptoms of dentinal

2016 UTHSCSA Dental School CAT Library

167. Adverse Immunologically Mediated Oral Mucosal Reactions to Systemic Medication: Lichenoid Tissue Reaction/Interface Dermatitis-Stomatitis, Autoimmune Vesiculobullous Disease, and IgE-Dependent and Immune Complex Reactions (PubMed)

Adverse Immunologically Mediated Oral Mucosal Reactions to Systemic Medication: Lichenoid Tissue Reaction/Interface Dermatitis-Stomatitis, Autoimmune Vesiculobullous Disease, and IgE-Dependent and Immune Complex Reactions Drug-induced hypersensitivity immune reactions are exaggerated immunoinflammatory responses to allergenic components of the medications that occur in genetically susceptible subjects. The type of hypersensitivity immune response generated, whether antibody mediated or T cell (...) mediated, or an immune complex reaction is determined by multiple factors, including the molecular characteristics of the allergen, the route of administration of the medication, the manner of presentation of the allergen by antigen-presenting cells to naïve T cells, the repertoire of the T cell receptors, and the cytokine profile within the microenvironment. This review deals with the clinical and histopathological aspects of adverse immunologically mediated oral mucosal reactions to systemic

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2018 Journal of immunology research

168. Human leukocyte antigens: key regulators of T-cell mediated drug hypersensitivity (PubMed)

Human leukocyte antigens: key regulators of T-cell mediated drug hypersensitivity Adverse drug reactions (ADR) can be broadly categorised as either on-target or off-target. On-target ADRs arise as a direct consequence of the pharmacological properties of the drug and are therefore predictable and dose-dependent. On-target ADRs comprise the majority (>80%) of ADRs, relate to the drug's interaction with its known pharmacological target and are a result of a complex interplay of genetic (...) and ecologic factors. In contrast, off-target ADRs, including immune-mediated ADRs (IM-ADRs), are due to unintended pharmacological interactions such as inadvertent ligation of host cell receptors or non-pharmacological interactions mediated through an adaptive immune response. IM-ADRs can be classified according to the primary immune cell involved and include B-cell-mediated (Gell-Coombs type I-III reactions) and T-cell-mediated (Gell-Coombs type IV or delayed hypersensitivity) reactions. IM-ADRs mediated

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2018 HLA

169. EAACI position paper: Comparing insect hypersensitivity induced by bite, sting, inhalation or ingestion in human beings and animals. (PubMed)

EAACI position paper: Comparing insect hypersensitivity induced by bite, sting, inhalation or ingestion in human beings and animals. Adverse reactions to insects occur in both human and veterinary patients. Systematic comparison may lead to improved recommendations for prevention and treatment in all species. In this position paper, we summarize the current knowledge on insect allergy induced via stings, bites, inhalation or ingestion, and compare reactions in companion animals to those

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2019 Allergy

170. The Diagnosis of Ceftriaxone Hypersensitivity in a Paediatric Population. (PubMed)

The Diagnosis of Ceftriaxone Hypersensitivity in a Paediatric Population. Penicillins and cephalosporins are the most frequent causes of hypersensitivity reactions (HRs) to drugs in children. Among cephalosporins for intravenous use, ceftriaxone (CT) is the most frequently prescribed in Italy. The aims of this study were to evaluate the diagnostic methods for CT hypersensitivity in a population of children with suspected HRs to this drug and their tolerance toward amoxi-cillin/clavulanic acid (...) (AMX/CLV).From 2012 to 2018, 90 children were investigated for suspected HRs to CT according to the European Academy of Allergy Asthma and Clinical Immunology (EAACI) guidelines.Ninety children had a history of reaction to CT. The majority (79/90; 77.8%) had a history of immediate reactions (IRs). CT hypersensitivity was confirmed in 26/90 patients (28.9%). In case of IRs, skin tests can be useful (24% of positive CT intradermal tests - IDTs) particularly in cases of anaphylaxis (81.8% of positive

2019 International Archives of Allergy and Immunology

171. Oral challenge without skin testing in children with suspected non-severe betalactam hypersensitivity. (PubMed)

Oral challenge without skin testing in children with suspected non-severe betalactam hypersensitivity. Suspected allergy to betalactam is common in children. However, the risk of anaphylaxis and fatal anaphylaxis is low, estimated at 0.015%-0.004% and 0.0015-0.002% of treated patients, respectively (1, 2). Up to recently, a provocation challenge was recommended in children with a suspected betalactam hypersensitivity (BH) and negative skin tests. However, these tests are painful, time-consuming (...) , require skilled team, appropriate setting and their role has been debated. In a study of Caubet et al., both skin tests and oral challenge test (OCT) were performed in 88 children with a history of mild non-immediate reactions with a betalactam antibiotic: 11 had an immediate positive intradermal test, but only 4 of them had a mild exanthema when challenged (3). In vitro and patch tests do not help for the diagnosis of these suspected drug reactions. This article is protected by copyright. All rights

2019 Pediatric Allergy and Immunology

172. NUDT15 Polymorphism identified in an Azathioprine Hypersensitivity Syndrome Presenting as Erythema Nodosum and Hepatotoxicity. (PubMed)

NUDT15 Polymorphism identified in an Azathioprine Hypersensitivity Syndrome Presenting as Erythema Nodosum and Hepatotoxicity. Azathioprine (AZA) is a thiopurine-derived immunosuppressant commonly used in autoimmune and immunobullous dermatoses. AZA-hypersensitivity syndrome is a rare, but potentially fatal, immune-mediated reaction occurring within four weeks of administration. The polymorphism of TPMT and NUDT15 gene has been shown to increase the risk of AZA-induced leukopenia1 . However (...) , the pharmacogenomic basis of in AZA-hypersensitivity remains unknown. Herein, we describe a case of AZA-hypersensitivity manifestating as erythema nodosum, gastrointestinal symptoms and hepatotoxicity with further NUDT15 polymorphism (rs116855232 C>T) identified. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

2019 British Journal of Dermatology

173. Immune Pathomechanism and Classification of Drug Hypersensitivity. (PubMed)

Immune Pathomechanism and Classification of Drug Hypersensitivity. Drug hypersensitivity reactions (DHR) are based on distinct mechanisms and are clinically heterogeneous. Taking into account that also off target activities of drugs may lead to stimulations of immune or inflammatory cells, three forms of DHR were discriminated: The allergic-immune mechanism relies on the covalent binding of drugs/chemicals to proteins, which thereby form new antigens, to which a humoral and/or cellular immune (...) response can develop. In IgE mediated drug allergies a possible tolerance mechanism to the drug during sensitization and the need of a covalent hapten-carrier link for initiation, but not for elicitation of IgE-mediated reactions are discussed. The p-i ("pharmacological interaction with immune receptor") concept represents an off target activity of drugs with immune receptors (HLA or TCR), which can result in unorthodox, allo-immune like stimulations of T cells. Some of these p-i stimulations occur

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2019 Allergy

174. Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways. (PubMed)

Drug-induced tubulointerstitial nephritis: hypersensitivity and necroinflammatory pathways. More than 250 drugs carry a small but important dose-independent risk of initiating a delayed-type hypersensitivity reaction that leads to acute tubulointerstitial nephritis (TIN). Clinical manifestations are often non-specific, making epidemiological studies challenging. In severe cases, if cessation of the offending drug is not followed by a prompt improvement in renal function, corticosteroid therapy

2019 Pediatric Nephrology

175. Skin tests are important in children with β-lactam hypersensitivity, but may be reduced in number. (PubMed)

Skin tests are important in children with β-lactam hypersensitivity, but may be reduced in number. There is no perfect agreement on how to perform an allergy work-up in suspected beta-lactam (BL) allergic children, since skin test (ST)-induced pain is often a limitation. The aim of the study was to assess the possibility of reducing the number of ST in children when performing a complete allergy work-up for BL hypersensitivity reactions. A retrospective analysis of all patients referring (...) to the Allergy Unit of the University Hospital of Montpellier (France) with positive responses in immediate- and non-immediate-reading ST to a BL over a 16-years period was performed, to determine the positive predictive value (PPV) of ST. All pediatric patients with a suspected BL hypersensitivity were skin tested with the suspected drug only, during the following 54 months. 319 patients reporting 328 BL reactions were included in the retrospective study. The PPV of ST for the reported drug was of 99.4

2019 Pediatric Allergy and Immunology

176. Presentation and natural history of progestogen hypersensitivity. (PubMed)

Presentation and natural history of progestogen hypersensitivity. To review the published medical literature on the clinical presentation, risk factors, and natural history of hypersensitivity reactions to progestogens.Through the use of PubMed, we conducted a review of allergy, dermatology, and obstetric literature for cases and case series of patients with hypersensitivity reactions to exogenous or endogenous progestogens. There are no longitudinal, prospective studies related to progestogen (...) hypersensitivity.Publications were selected that described cases that were clinically consistent with progesterone hypersensitivity and positive test results or clear symptoms with exposure to progestogens to confirm the diagnosis.Progestogen hypersensitivity symptoms can be triggered by endogenous progesterone or exogenous progestins used for contraception or fertility treatments. Symptoms are varied and include dermatitis, urticaria, asthma, and anaphylaxis.Although the medical literature on progestogen hypersensitivity

2019 Asthma & Immunology

177. Efficacy and tolerability of desensitization in the treatment of delayed drug hypersensitivities to anti-tuberculosis medications. (PubMed)

as a prospective, observational cohort study. Subjects who experienced hypersensitivity reactions, including maculopapular exanthema (MPE) and drug reaction with eosinophilia and systemic symptoms (DRESS), to first-line anti-tuberculosis medications (isoniazid [INH], ethambutol [EMB], rifampin [RFP], and pyrazinamide [PZA]) were enrolled. Patch, intradermal, lymphocyte transformation, and oral provocation tests were performed to determine culprit drugs, which were desensitized with rapid and graded challenge (...) Efficacy and tolerability of desensitization in the treatment of delayed drug hypersensitivities to anti-tuberculosis medications. Delayed drug hypersensitivity to first-line anti-tuberculosis medication is a major challenge in tuberculosis treatment.This study was performed to investigate the efficacy/tolerability of desensitization therapy in treatment of first-line anti-tuberculosis medication hypersensitivity and the usefulness of immunologic evaluation therein.This study was conducted

2019 Respiratory medicine

178. Vancomycin-associated Drug-Induced Hypersensitivity Syndrome (DIHS). (PubMed)

Vancomycin-associated Drug-Induced Hypersensitivity Syndrome (DIHS). While hypersensitivity reactions are well-characterized for certain medications, vancomycin-associated drug-induced hypersensitivity syndrome (DIHS), or drug reaction with eosinophilia and systemic symptoms (DRESS), has yet to be defined.To better define the clinical phenotype of vancomycin-associated DIHS.A retrospective case series was conducted over an 8-year period at a single, academic institution. Twenty-nine patients (...) with definitive DIHS/DRESS were identified, of which four cases were attributed to vancomycin. A literature review was performed which identified 28 additional cases of vancomycin-induced DIHS. Vancomycin-associated acute interstitial nephritis (AIN) was also reviewed to detect further, previously uncharacterized cases of systemic hypersensitivity. This yielded 11 additional cases.In this literature review and retrospective series, the incidence of renal dysfunction among vancomycin-induced cases (75% and 68

2019 Journal of the American Academy of Dermatology

179. In vitro diagnostic tests for perioperative hypersensitivity, a narrative review: potential, limitations, and perspectives. (PubMed)

immunoglobulin E antibodies, serum tryptase, and plasma histamine, as well as basophil activation tests is becoming widespread. These latter tests have the advantage of having no risk of recurrence of immediate hypersensitivity reactions. In this narrative review, we summarise the principles of these in vitro tests, and the possibilities and limitations when these tests are used for testing sensitivity to substances with a high risk of causing perioperative hypersensitivity. Hence, we focus on neuromuscular (...) In vitro diagnostic tests for perioperative hypersensitivity, a narrative review: potential, limitations, and perspectives. Correct diagnostic management of perioperative hypersensitivity aims to identify the underlying mechanism(s), responsible culprit(s), and safe alternative drugs or techniques. Although drug provocation tests are considered the gold standard, diagnosis of perioperative hypersensitivity mainly relies on skin testing. Use of in vitro tests, such as quantification of specific

2019 British Journal of Anaesthesia

180. Molecular mechanisms and pathophysiology of perioperative hypersensitivity and anaphylaxis: a narrative review. (PubMed)

Molecular mechanisms and pathophysiology of perioperative hypersensitivity and anaphylaxis: a narrative review. Perioperative hypersensitivity reactions (POH) constitute a clinical and diagnostic challenge, a consequence of heterogeneous clinical presentations, and multiple underlying pathomechanisms. POH do not necessarily involve an allergen-specific immune response with cross-linking of specific immunoglobulin E (sIgE) antibodies on mast cells and basophils. POH can also result from

2019 British Journal of Anaesthesia

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