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Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases.
Eur Ann Allergy Clin Immunol. 2009 Apr; 41(2):50-5.EA

Abstract

BACKGROUND

Subjects with drug hypersensitivity are sometimes simultaneously reactive to several drugs. This nosological entity is defined as multiple drug hypersensivity (MDH). Urticaria and angioedema are the commonest clinical manifestations of hypersensitivity drug reactions (HDR). These clinical signs are also pathognomonic of chronic idiopathic urticaria (CIU), whose pathogenetic mechanisms are still largely unknown. The diagnostic algorithm of CIU includes autologous serum skin test (ASST) and autologous plasma skin test (APST), which demonstrated a high positive and negative predictive value, in multiple nonsteroidal anti-inflammatory drugs (NSAIDs) intolerance.

OBJECTIVE

to explore the underlying mechanism of MDH and to assess the correlation between such tests and autoimmune diseases (AD).

METHODS

Twenty eight subjects with MDH referred to our Allergy/Immunology Unit were enrolled from May 2006 to May 2007. Eight healthy subjects served as controls. In addition to common diagnostic tools used in the diagnostic algorithm of MDH, enrolled subjects also underwent ASST and APST.

RESULTS

Patients were predominantly female (23 female vs. 5 male; mean age 52.2 years). In 61% of cases MDH was associated with either CIU or AD. NSAIDs and antibiotics were the major causes of HIDR, both implied in 54% of subjects. The proportions of MDH-subjects with positive ASST and APST were 46.4% and 28.6%, respectively. All patients with MDH+AD+CIU (4/4) presented apositive ASST.

CONCLUSIONS

In patients with MDH, ASST proved to be frequently positive, as previously described for multiple NSAIDs intolerance. In ASST-positive subjects, the activity of several drugs appears to add up FceRI-specific autoantibodies in the induction of the release of allergic mediators.

Authors+Show Affiliations

Allergy and Immunology Department, IRCCS San Raffaele Hospital, Milan, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19585860

Citation

Colombo, G, et al. "Multiple Drug Hypersensivity: Insight Into the Underlying Mechanism and Correlation With Autoimmune Diseases." European Annals of Allergy and Clinical Immunology, vol. 41, no. 2, 2009, pp. 50-5.
Colombo G, Yacoub MR, Burastero SE, et al. Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases. Eur Ann Allergy Clin Immunol. 2009;41(2):50-5.
Colombo, G., Yacoub, M. R., Burastero, S. E., Garattini, E., Girlanda, S., Saporiti, N., Salvo, F., & Sabbadini, M. G. (2009). Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases. European Annals of Allergy and Clinical Immunology, 41(2), 50-5.
Colombo G, et al. Multiple Drug Hypersensivity: Insight Into the Underlying Mechanism and Correlation With Autoimmune Diseases. Eur Ann Allergy Clin Immunol. 2009;41(2):50-5. PubMed PMID: 19585860.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multiple drug hypersensivity: insight into the underlying mechanism and correlation with autoimmune diseases. AU - Colombo,G, AU - Yacoub,M R, AU - Burastero,S E, AU - Garattini,E, AU - Girlanda,S, AU - Saporiti,N, AU - Salvo,F, AU - Sabbadini,M G, PY - 2009/7/10/entrez PY - 2009/7/10/pubmed PY - 2009/9/3/medline SP - 50 EP - 5 JF - European annals of allergy and clinical immunology JO - Eur Ann Allergy Clin Immunol VL - 41 IS - 2 N2 - BACKGROUND: Subjects with drug hypersensitivity are sometimes simultaneously reactive to several drugs. This nosological entity is defined as multiple drug hypersensivity (MDH). Urticaria and angioedema are the commonest clinical manifestations of hypersensitivity drug reactions (HDR). These clinical signs are also pathognomonic of chronic idiopathic urticaria (CIU), whose pathogenetic mechanisms are still largely unknown. The diagnostic algorithm of CIU includes autologous serum skin test (ASST) and autologous plasma skin test (APST), which demonstrated a high positive and negative predictive value, in multiple nonsteroidal anti-inflammatory drugs (NSAIDs) intolerance. OBJECTIVE: to explore the underlying mechanism of MDH and to assess the correlation between such tests and autoimmune diseases (AD). METHODS: Twenty eight subjects with MDH referred to our Allergy/Immunology Unit were enrolled from May 2006 to May 2007. Eight healthy subjects served as controls. In addition to common diagnostic tools used in the diagnostic algorithm of MDH, enrolled subjects also underwent ASST and APST. RESULTS: Patients were predominantly female (23 female vs. 5 male; mean age 52.2 years). In 61% of cases MDH was associated with either CIU or AD. NSAIDs and antibiotics were the major causes of HIDR, both implied in 54% of subjects. The proportions of MDH-subjects with positive ASST and APST were 46.4% and 28.6%, respectively. All patients with MDH+AD+CIU (4/4) presented apositive ASST. CONCLUSIONS: In patients with MDH, ASST proved to be frequently positive, as previously described for multiple NSAIDs intolerance. In ASST-positive subjects, the activity of several drugs appears to add up FceRI-specific autoantibodies in the induction of the release of allergic mediators. SN - 1764-1489 UR - https://www.unboundmedicine.com/medline/citation/19585860/Multiple_drug_hypersensivity:_insight_into_the_underlying_mechanism_and_correlation_with_autoimmune_diseases_ L2 - http://www.diseaseinfosearch.org/result/675 DB - PRIME DP - Unbound Medicine ER -