Asia Pacific Allergy最新文献

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe adverse cutaneous reactions, most commonly triggered by medications, characterized by extensive necrosis and detachment of the epidermis.

Objective: We investigated the differences in clinical characteristics of drug-induced SJS/TEN depending on the type of drug in a single center.

Methods: The relevance of sex, age, culprit drugs, clinical features, courses, treatment options, and follow-up results were retrospectively evaluated in patients diagnosed with drug-induced SJS/TEN at Pusan National University Hospital between 2008 and 2019.

Results: Ninety-two patients with a mean age of 58.7 ± 20.2 years (range, 10-93 years) were included in the study. Those aged 60-80 years accounted for the largest number of patients (42.4%). Patients with drug-induced SJS/TEN comprised 40 women (43.5%) and 52 men (56.5%). We categorized drug-induced SJS/TEN cases by culprit drugs into 6 groups: antibiotics, allopurinol, antiepileptic (AED), nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and other drugs. The rate of NSAID-induced disease significantly increased from SJS to TEN (p = 0.016). Among the patients in the NSAID group, the proportion of TEN (40%) was higher than that in the other groups (p = 0.021). The mean body surface area was significantly lower in the AED group than in the non-AED groups (7.1 ± 9.8 vs. 23.1 ± 27.3, p = 0.020) and higher in the NSAID group than in the non-NSAID groups (47.5 ± 39.5 vs. 15.7 ± 20.0, p = 0.010).

Conclusion: This study showed that the clinical characteristics of each causative drug group may be different in drug-induced SJS/TEN. Our findings may help clinicians better understand drug-induced SJS/TEN.

Background: Allergic rhinitis (AR) has substantially negative impacts on patients' quality of life. Besides conventional medicines, many patients use alternative approaches, which sometimes were misconception.

Objective: This study aims to explore and compare the beliefs about AR and its treatment options between 2 different groups; control and AR patient groups.

Methods: A cross-sectional study of 518 respondents residing in the central region of Thailand has been conducted using a self-reported questionnaire which consists of 3 parts; personal profile, the International Study of Asthma and Allergies in Childhood (ISAAC) questions, and the beliefs. ISAAC is applied for identifying respondents as the control or the AR group.

Results: From a total of 518 respondents, 311 (60.0%) were identified as the AR group. The demographic data between the control and the AR group has no statistical difference (p > 0.05). Regarding the beliefs about AR characteristics, 56.1% of the AR group believe that low immunity causes AR while the number of the control group reaches 56%. Thirty-nine point two percent for the AR group and 38.6% for the control group believe that AR is a fatal disease. The belief that AR can be spread by droplet/airborne transmission is 22.8% and 28.5% for the AR and the control group, respectively. About AR treatment options, 60.1% of the AR group and 43% of the control group believe that taking vitamin C can relieve AR symptoms, which has a statistical difference (p < 0.05) between the 2 groups. The belief that prolonged use of antihistamine drugs can cause drug resistance is 29.9% and 24.6% for AR and control groups, respectively.

Conclusion: Both groups of respondents mostly share common beliefs about AR characteristics and treatment options in which the AR group has higher percentage in some beliefs. Therefore, health literacy should be promoted in order to improve patient's care.

Cytokine release syndrome (CRS) is a type of hypersensitivity reaction which has been previously described with chemotherapy and monoclonal antibodies, but not with antibiotics. We present 2 pediatric cases of Amoxicillin/Clavulanic acid (Augmentin) anaphylaxis resembling CRS. Both our patients presented during the index reaction with symptoms suggestive of an acute systemic inflammatory response mimicking sepsis. Their symptomology was reproducible at drug provocation test as anaphylaxis, but with suboptimal response to intramuscular adrenaline. Their infective workups were unremarkable and illnesses followed a self-limiting course. All these point towards a severe hypersensitivity reaction resembling CRS.

Delayed hypersensitivity reaction of penicillin is commonly seen, but never reported in pyridium. This case illustrates a patient with delayed hypersensitivity reaction after the use of augmentin and pyridium. Skin patch test, surprisingly, confirmed pyridium delayed hypersensitivity.

Background: Intranasal corticosteroid (INCS) is one of the most effective treatments for allergic rhinitis (AR). To achieve optimum efficiency while avoiding adverse effects (AEs), patients must comply with and follow the drug administration instructions.

Objective: To evaluate INCS administration techniques and steps and the association between inaccurate drug administration and AEs.

Methods: A descriptive cross-sectional study was performed in patients diagnosed with AR who had used an INCS for more than 1 month at the HRH Princess Maha Chakri Sirindhorn Medical Center, Nakhon Nayok, Thailand between September 2020 and August 2021. Patient information was collected, evaluate the accuracy of the application techniques and the steps they followed for INCS administration and the occurrence of any associated AEs.

Results: In total, 150 subjects diagnosed with AR met the criteria. Only 6 patients (4%) correctly performed all 12 steps of INCS administration, while 44 patients (29.33%) correctly performed the 5 recommended essential steps. AEs were found in 23 patients (15.33%), with not pointing the tip slightly outward away from the septum significantly associated with a 3.6 times higher risk of AEs in patients (odds ratio, 3.6; 95% confidence interval, 1.3-9.4; p = 0.012).

Conclusion: Investigations into INCS use in patients with AR revealed that only 4% of patients correctly performed all the administration techniques and steps, while 30% of patients at least followed the 5 recommended essential steps perfectly. Not pointing the tip slightly outward away from the septum was found to result in the most AEs.

Trial registration: Thai Clinical Trials Registry: TCTR-20210718003.

Background: Allergen-specific immunotherapy (AIT) is accepted as the only disease-modifying therapy for IgE-mediated allergic airway diseases and hymenoptera venom allergy. AIT requires repeated contact between patient and physician or nurse in the hospital. Because it is a long-term treatment, compliance is essential issue to obtain maximal efficacy. Coronavirus disease 2019 (COVID-19) pandemic reshaped doctor-patient interaction and pattern of hospital admissions.

Objective: We aimed to determine the possible changes in the administration of AIT and associated factors, in addition to the characteristics of patients diagnosed with COVID-19 infection.

Methods: Adult patients who underwent AIT for hymenoptera venom allergy, allergic rhinitis or allergic asthma between 11 March 2020 and 31 January 2021 were included in our retrospective study. Perennial and preseasonal AIT practices were evaluated. We identified patients with COVID-19 infection among the ones who received AIT.

Results: The mean age of 215 patients was 37.8±11.9 years and 52.1% of the patients were female. In our study, 35.4% of perennial AIT patients did not continue treatment after the COVID-19 pandemic, and the cause was patient-related in 66.7% of the cases. Compliance was 70.7% in patients receiving perennial AIT. The highest compliance rate for AIT was for venom allergy (86.5%). Thirty-four patients (15.8%) were diagnosed with COVID-19 infection. No mortality due to COVID-19 infection was observed in those who underwent AIT.

Conclusion: COVID-19 pandemic has reduced compliance to AIT. Compliance was higher in venom immunotherapy than in aeroallergens. Severe COVID-19 infection and COVID-19 related death were not observed in patients receiving AIT.