Anaphylaxis, Urticaria, Angioedema

The reaction time is short and depends to some extent on the nature of the allergen and the route of administration  

The course of drug-induced urticaria is acute. In the vast majority of cases the lesions heal within 1-3 days without leaving any residual changes. However, the condition can assume a chronic form and the lesions can recur repeatedly over many weeks. Such events are most commonly observed in penicillin allergy. Small amounts of penicillins can be detected in foodstuffs, especially dairy products, in vaccines, secretions (saliva, semen), and furthermore they are produced by various molds (Hyphomycetes) which are found everywhere in our environment and hence gain entry to our bodies every day (Cole and Robinson 1961 McGovern et al. 1970 JiLLSON and Porter 1965 Stewart 1965 Un and Valu 1963), However, it is only in a small proportion of patients that the manifestations persist and it may be doubted whether the widespread occurrence of traces of penicillin is enough to explain why some cases of acute penicillin urticaria become chronic. 

The causes of anaphylactic reactions include not only drugs of high molecular weight (over 5,000) but also those consisting of small molecules. Drugs known to cause urticaria and anaphylaxis are  

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Systemic reactions to PPIs include anaphylaxis, urticaria, angioedema, interstitial nephritis, cytopenia, thromboqdopenia, and vasculitis. 

Aspirin and NSAIDs can induce allergic and pseudoallergic reactions. Because these drugs are used so widely, with much over-the-counter use, the health care professional must have a basic understanding of the types of reactions that can occur and how to prevent them. Three types of reactions occur bron-chospasm with rhinoconjunctivitis, urticaria/angioedema, and anaphylaxis. Remember that patients with gastric discomfort... 

Hypersensitivity reactions Immediate hypersensitivity reactions may occur after administration of ipratropium as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. Pregnancy Category B. 

Hypersensitivity reactions Severe acute hypersensitivity reactions (eg, urticaria, angioedema, bronchoconstriction, anaphylaxis) have been rarely observed during alpha interferon and ribavirin therapy. 

Only nine allergic reactions to cuttlefish have been described (Caffarelli et ah, 1996 Ebisawa et ah, 2003 Shibasaki et ah, 1989). One patient was a 10-year-old female who experienced a severe reaction to ingestion of cuttlefish that was manifested by urticaria, angioedema, asthma, abdominal pain, laryngeal edema, and hypotension (Shibasaki et ah, 1989). SPT and RAST were positive. This patient reportedly tolerated octopus, clam, oyster, abalone, mussel, and scallop but reacted to crab and shrimp. Caffarelli et ah (1996) describe a 14-year-old female who had cuttlefish-dependent, exercise-induced anaphylaxis. Ebisawa et ah (2003) reported 7 cases of allergy to cuttlefish among a series of 305 pediatric cases of food allergy but provided no specifics on the circumstances or symptoms of these patients. 

Serious, acute hypersensitivity reactions, such as urticaria, angioedema, broncho-constriction, and anaphylaxis, may occur. Other rare reactions include pancreatitis, colitis, endocrine disorders (e.g., diabetes mellitus), hyperthyroidism or hypothyroidism, ophthalmologic, neuropsychiatric, autoimmune, ischemic, infectious, and pulmonary disorders. 

Type I IgE-mediated acute allergic reactions to stings, pollens, and drugs, including anaphylaxis, urticaria, and angioedema. IgE is fixed to tissue mast cells and blood basophils, and after interaction with antigen the cells release potent mediators. 

Type I reactions are IgE mediated and cause manifestations of allergic symptoms due to the release of immune mediators such as histamine or leukotrienes. These reactions typically occur within minutes of drug exposure and may manifest as generalized prurituS/ urticaria/ angioedema/ anaphylaxiS/ rhinitiS/ or conjunctivitis (21). Anaphylaxis can result from exposure to any antigen (e.g./ penicillin) and may be fatal in the absence of prompt medical intervention. 

Two patients who were sensitized to a member of the Asteraceae (Compositae) family, mugwort, had severe systemic reactions (anaphylaxis and generalized urticaria/ angioedema) due to honey and royal jelly (13). Both had positive skin tests and RAST to mugwort, and in one case... 

The International Rheumatic Fever Study, a prospective multicenter study that recorded allergic reactions, defined as hypotension, dyspnea, pruritus, urticaria, angioedema, arthralgia, and maculopapular rash in 1790 patients treated with monthly intramuscular benzathine penicillin for prophylaxis of rheumatic fever (32 430 injections during 2736 patient years). There was a 3.2% case incidence of allergic reactions and a 0.2% case incidence of anaphylaxis (12/100000 injections), including one death (0.05%, equivalent to 3.1/ 100000 injections) (233). 

Among the anaphylactic reactions to NSAIDs that result in different types of reaction (urticaria, angioedema, asthma, or hypotension), there have been very few reports of anaphylactic shock. However, anaphylaxis has been described in patients taking celecoxib (135,136) or rofecoxib (137). Rofecoxib caused anaphylaxis in a patient who had had a similar reaction to diclofenac, suggesting that COX-2 inhibitors may be not safe in all individuals who have adverse reactions to non-selective COX inhibitors. It also suggests that different mechanisms may be involved in patients with asthma and in those with anaphylactoid reactions to NSAIDs. 

Anaphylaxis due to celecoxib has been described (SEDA 26, 121). Life-threatening anaphylaxis, with urticaria, angioedema, and bronchospasm, has also been described 30 minutes after a dose of celecoxib for arthritis of the hip (128). 

Severe anaphylaxis has been reported in two patients with infected wounds that had been treated with topical rifamycin for several months (82). There was urticaria, angioedema, and hypotension in one case, and urticaria, wheezing, dyspnea, and hypotensive shock in the other. In both cases, prick tests with 10% rifamycin solution were positive, while there were no positive reactions in 20 controls. 

Metabisulfite-induced anaphylaxis through an IgE-mediated mechanism has been described in a patient who developed urticaria, angioedema, and nasal congestion following provocative challenge with sodium metabisulfite (6). 

Adverse reactions Overall, the penicillins are well tolerated. The most common adverse effects are due to hypersensitivity reactions. Hypersensitivity reactions can be simply categorized as immediate reactions (type 1) or late reactions. Type 1 reactions are IgE mediated and are often associated with systemic manifestations such as diffuse erythema, pruritus, urticaria, angioedema, and bronchospasm. The most severe yet rare IgE-mediated side effect is anaphylaxis (0.05%). Type 1 reactions usually occur within 72 hr of administration. Late reactions usually occur 72 hr after drug administration. The most common late reactions include skin rashes characterized as maculopapular or morbilliform rashes. Rarely, nafcillin may cause neutropenia. Seizures in high doses, vaginal moniliasis, and Clostridium difficile infection also can occur with all penicillins... 

Cephalosporins should not be used in individuals with immediate-type hypersensitivity reaction (urticaria, angioedema, or anaphylaxis) to penicillins. 

Anaphylaxis Serum sickness-like reaction Drug fever Vasculitis Generalized lymphadenopathy Maculopapular/morbilliform eruptions Urticaria/ angioedema SJS TEN Contact dermatitis... 

Hj antagonists are most useful in acute types of allergy that present with symptoms of rhinitis, urticaria, and conjunctivitis. Their effect is confined to the suppression of symptoms attributable to the histamine released by the antigen-antibody reaction. In bronchial asthma, systemic anaphylaxis and angioedema, histamine antagonists have limited efficacy and are not used as sole therapy. 

Contact urticaria, angioedema, and anaphylaxis Penetration of irritants through gloves Others endotoxin reactions, ethylene oxide, chemical leukoderma... 

Immnnologic A 56-year-old woman had three episodes of anaphylaxis while taking oral minocycline [66 ]. After an oral challenge test with minocycline she developed urticaria, angioedema, nausea, vomiting, hypotension, and dyspnea within 4 minutes and was given intramuscular adrenaline, an intravenous antihistamine, and a glucocorticoid, but developed similar symptoms after 50 and 110 minutes. 

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