Journal of Investigational Allergy and Clinical Immunology最新文献

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Kounis syndrome during an oxaliplatin desensitization protocol 奥沙利铂脱敏方案期间的库尼斯综合征

Journal of Investigational Allergy and Clinical Immunology

Pub Date : 2023-12-05 DOI: 10.18176/jiaci.0971

N. Giangrande, A. Carral Maseda, JA Lopez Arias, L. Perez Casares, J. Martin Lázaro, R. Núñez Orjales, LA Gonzalez Guzman, F. Carballada González

引用次数: 0

Nonimmediate Hypersensitivity Reaction to Rifaximin Confirmed With a Drug Challenge Test 利福昔明非立即超敏反应经药物激发试验证实

Journal of Investigational Allergy and Clinical Immunology

Pub Date : 2021-10-22 DOI: 10.18176/jiaci.066010.18176/jiaci.0660

B. Moya, I. García-Moguel, R. Mielgo, L. Herráez, JF Crespo

J Investig Allergol Clin Immunol 2021; Vol. 31(5): 446-460 © 2021 Esmon Publicidad pustules, mucosal involvement, skin hyperpigmentation, or desquamation. Her skin lesions resolved spontaneously 7 days after discontinuation of rifaximin. After obtaining the patient’s written informed consent, we performed an allergological work-up, including skin prick test (SPT) and a graded DCT with rifaximin. SPT was performed with rifaximin at 1 mg/mL on the volar aspect of the forearm and yielded a negative result [6]. On the same day, the patient underwent a DCT, consisting of a graded oral challenge starting at 50 mg and followed by 150 mg 30 minutes later, up to a final dose of 200 mg. One hour after the DCT, the patient felt nauseous, with diarrheic stool that resolved spontaneously without medication. The DCT was considered inconclusive and repeated 24 hours later. Three hours after completion of the second DCT, the patient again experienced diarrheic stools. Ten hours after the DCT, she developed a maculopapular erythematous and pruritic skin rash on her abdomen and left arm (Figure). She was treated with oral prednisone 0.5 mg/kg/d for 3 days and loratadine 10 mg/d for 7 days until the skin lesions resolved, without desquamation or residual lesions. The rationale for an allergological study with rifaximin was that the patient had a long history of gastrointestinal infections, in which rifaximin is an effective first-line therapy. Although reactions to rifamycins (eg, fever, rash, flu-like syndrome, acute renal failure, hemolytic anemia, thrombocytopenia, and anaphylaxis) have been reported [7], few reactions to rifaximin have been described since it was approved [3,4]. In the present case, the patient initially developed gastrointestinal symptoms 3 hours after receiving the first dose of rifaximin; these were considered a nonimmune adverse reaction to rifaximin. She continued treatment, developing a mild maculopapular Nonimmediate Hypersensitivity Reaction to Rifaximin Confirmed With a Drug Challenge Test

[J] contemporary medicine; 2011;第31卷(5):446-460©2021 Esmon Publicidad脓疱，粘膜累及，皮肤色素沉着，或脱屑。她的皮肤病变在停用利福昔明7天后自行消退。在获得患者的书面知情同意后，我们进行了过敏检查，包括皮肤点刺试验(SPT)和利福昔明分级DCT。用利福昔明在前臂掌侧以1mg /mL剂量进行SPT，结果为阴性[6]。在同一天，患者接受了DCT，包括从50 mg开始的分级口服攻击，30分钟后增加150 mg，直到最终剂量为200 mg。DCT 1小时后，患者感到恶心，腹泻便自行消退，无需药物治疗。DCT被认为是不确定的，并在24小时后重复。第二次DCT完成3小时后，患者再次出现腹泻性便。DCT 10小时后，患者腹部和左臂出现斑疹性红斑和瘙痒性皮疹(图)。患者口服强的松0.5 mg/kg/d，连用3天，氯雷他定10 mg/d，连用7天，直至皮损消退，无脱屑或残留皮损。对利福昔明进行过敏学研究的理由是，患者有长期的胃肠道感染史，其中利福昔明是有效的一线治疗。虽然对利福昔明的不良反应(如发热、皮疹、流感样综合征、急性肾功能衰竭、溶血性贫血、血小板减少症和过敏反应)已有报道[7]，但自利福昔明获批以来，对其不良反应的报道很少[3,4]。在本病例中，患者最初在接受第一剂利福昔明3小时后出现胃肠道症状;这些被认为是利福昔明的非免疫不良反应。她继续治疗，对利福昔明出现轻度黄斑丘疹非立即过敏反应，经药物激发试验证实

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