Vitamin hypersensitivity

The bile acid sequestrants are contraindicated in patients with known hypersensitivity to the drugs. Bile acid sequestrants are also contraindicated in those with complete biliary obstruction. These drags are used cautiously in patients with a history of liver or kidney disease Bile acid sequestrants are used cautiously during pregnancy (Pregnancy Category C) and lactation (decreased absorption of vitamins may affect the infant). 

Hypersensitivity to cobalt, vitamin B-12, or any component of these products. 

IV use Severe reactions, including fatalities, have occurred during and immediately after IV injection, even with precautions to dilute the injection and to avoid rapid infusion. These severe reactions resemble hypersensitivity or anaphylaxis, including shock and cardiac or respiratory arrest. Some patients exhibit these severe reactions on receiving vitamin Kfor the first time. Therefore, restrict the IV route to those situations where other routes are not feasible and the serious risk involved is justified. 

Hydroxocobalpinin (Vitamin Bu) [Vitamin/Antidote] Uses Tx of cyanide poisoning Action Binds cyanide molecules to form cyanocobal-amin to facilitate excretion Dose Adults. 5 g IV once Feds. 70 mg/kg IV once Caution [C, ] Contra Hypersensitivity to hydroxocobalamin Disp Inj SE ... 

Contraindications Hypercalcemia or evidence of vitamin D toxicity, use on face, hypersensitivity to calcipotriene or any component of the formulation... 

Contraindications Hypercalcemia, malabsorption syndrome, vitamin D toxicity, hypersensitivity to other vitamin D products or analogs... 

Vitamin B12 deficiency normally results from indequate absorption rather than inadequate dietary intake. Pernicious anaemia is caused by vitamin B12 deficiency symptoms include anaemia, glossitis, fatigue and degeneration of the peripheral nervous system and hypersensitivity of the skin. The adult RDA and RNI for B12 are 2 and 1.5 figday- respectively. Unlike other vitamins, B12 is obtained exclusively from animal food sources, such as meat, fish, poultry, eggs, shellfish, milk, cheese and eggs. Vitamin B12 in these foods is protein-bound and released by the action of HC1 and pepsin in the stomach. 

Another argument against simple vitamin D overdosage or hypersensitivity in idiopathic hypercalcemia is the response to withdrawal of all vitamin D. In even the grossest cases of vitamin D poisoning in... 

The cephalosporins are contraindicated in patients with known allergies or intolerances to any of the cephalosporins. Because the penicillins and cephalosporins have a common chemical structure, cross-allergies occur with these drugs. Thus before initiating therapy with a cephalosporin, careful inquiry should be made concerning previous hypersensitivity reactions to the other drugs. Because a secondary vitamin K deficiency can develop with cephalosporin use, the cephalosporins are contraindicated in patients with hemophilia. Cefaclor is also contraindicated in any patient with previous drug-related joint and skin reactions. 

In 20-25% of cases, side effects are observed, depending mainly on the dose (hypersensitivity reactions, aphthous lesions, arthralgia, nausea, fever). All in all, treatment of Wilson s disease with penicillamine is considered to be successful and safe. If jrenicill-amine is not well tolerated or if serious side effects are observed (e.g. kidney or bone-marrow damage, polyneuropathy, pemphigus), treatment must be discontinued. Penicillamine usually causes pyridoxin deficiency, so that substitution (25—40 mg/day) is recommended, particularly as chronic liver damage also leads to vitamin Bg deficiency. If necessary, electrolytes and trace elements also have to be substituted. 

Wu SF, Chen W. Hypersensitivity to vitamin preparation in parenteral nutrition report of one case. Acta Paediatr Taiwan 2002 43(5) 285-7. 

Allergy to vitamin B12 injection is infrequent, but can be serious. Positive results of basophil histamine release assay and skin testing suggest an IgE-mediated mechanism (5). Severe hypersensitivity to cyanoco-balamin or hydroxocobalamin has been reported in patients who took the other cobalamin without further allergic reactions (6). 

A child with X-linked hypophosphatemic rickets developed vitamin D intoxication during treatment with alfacalcidol and phosphorus. Besides the usual findings in this condition he had precocious synostosis of the skull, with signs of raised intracranial pressure. In view of earlier reports of coincidence of craniostenosis and X-linked hypophosphatemic rickets the authors pointed to the possibility that intoxication with alfacalcidol was the precipitating factor. In addition, hypersensitivity to alfacalcidol was found 2 months after the end of treatment, with normal concentrations of calcitriol (56). 

Neonates with subcutaneous fat necrosis can have transient hypersensitivity to vitamin D (61). There is a relation between the syndrome known as infantile idiopathic hypercalcemia and vitamin D intake and/or vitamin D metabolism (26). 

Wehinger H. Spatrachitis nach Vitamin-D-Uberempfindhchkeit bei Adiponekrosis subcutanea in der Neugeborenenperiode. [Vitamin D deficiency rickets after vitamin D hypersensitivity with subcutaneous fat necrosis in the newborn period.] Z Kinderheilkd 1969 107(l) 42-52. 

In all reported cases, only the whole formulation of vitamin Ki (in its vehicle) or vitamin Ki alone elicited positive patch tests. When individual additives were tested the results were negative. No previous exposure to vitamin Ki was required for the development of type IV hypersensitivity, and primary sensitization occurred within 1-2 weeks or after a longer time period, as in the patient described here. 

Bruynzeel I, Hebeda CL, Folkers E, Bruynzeel DP. Cutaneous hypersensitivity reactions to vitamin K 2 case reports and a review of the literature. Contact Dermatitis 1995 32(2) 78-82. 

Keough GC, English JC 3rd, Meffert JJ. Eczematous hypersensitivity from aqueous vitamin K injection. Cutis 1998 61(2) 81-3. 

Moreau-Cabarrot A, Giordano-Labadie F, Bazex J. Hypersensibilite cutanee au point d injection de vitamin Kl. [Cutaneous hypersensitivity at the site of injection of vitamin Kl.] Ann Dermatol Venereol 1996 123(3) 177-9. 

Chung JY, Ramos-Caro FA, Beers B, Ford Ml, Flowers FP. Hypersensitivity reactions to parenteral vitamin K. Cutis 1999 63(1) 33. ... 

Sommer S, Wilkinson SM, Peckham D, Wilson C. Type IV hypersensitivity to vitamin K. Contact Dermatitis 2002 46(2) 94-6. 

Drug interactions May decrease antihypertensive effects of ACE inhibitors, angiotensin II antagonists. May decrease antihypertensive and diuretic effects of thiazide and loop diuretics May decrease absorption of vitamin B,2 Effects decreased by barbiturates, phenytoin, and rifampin decreases effect of salicylates and vaccines Decreases clearance of beta-lactams Risk for hypersensitivity increased in patients who are on thiazides or ACE inhibitors and allopurinol... 

Polysorbates are widely used in cosmetics, food products, and oral, parenteral, and topical pharmaceutical formulations and are generally regarded as nontoxic and nonirritant materials. There have, however, been occasional reports of hypersensitivity to polysorbates following their topical and intramuscular use. Polysorbates have also been associated with serious adverse effects, including some deaths, in low-birthweight infants intravenously administered a vitamin E preparation containing a mixture of polysorbates 20 and 80. When heated to decomposition, the polysorbates emit acrid smoke and irritating fumes. 

Although several mechanisms have been proposed to be responsible for causing CRS, none has been extensively studied. One hypothesis has been that the effects are due to an immediate hypersensitivity reaction. Since no IgE-mediated reaction has been documented, there is no direct evidence that this is the case. Another hypothesis is that vitamin Bg deficiency plays a role in the response because the symptoms were prevented by supplementing individuals with the vitamin. Since glutamate can be converted to acetylcholine by the tricarboxylic acid cycle, it has also been proposed that the effects are due to an increase in acetylcholine levels. It has been noted that after MSG ingestion, there is a decrease in cholinesterase levels. Due to inadequate investigations, it is not currently known if any or all of these mechanisms are responsible for CRS. The neurotoxicity of MSG, demonstrated after exposure... 

Contraindications Hypercalcemia, hypervitaminosis D, or renal osteodystrophy with hyperphosphatemia. Use with caution in patients with arteriosclerosis, hyperphosphatemia, hypersensitivity to vitamin D, and renal or cardiac impairment. 

Sailstad DM, Boykin EH, Slade R, et al. The effect of vitamin A acetate diet on ultraviolet radiation-induced immune suppression as measured by contact hypersensitivity in mice. Photochem Photobiol 2000 72(6) 766—71. 

The manufacturer s guidelines recommend initiating IVLE in adults with a test dose of 0.5 to 1 mL/min for the first 15 to 30 minutes because of the potential for an immediate hypersensitivity reaction. In most patients, this is probably not necessary because of the relatively low incidence and benign nature of acute adverse reactions. In addition, infusion over 20 to 24 hours eliminates the need for a test dose because the infusion rate is less than the test-dose rate recommended by the manufacturer. Appropriate electrolytes should be provided to patients with normal organ function based on standard nutrient ranges. Adjustments may be necessary depending on the patient s clinical condition. Adults and children older than 11 years of age should receive daily amounts of trace elements and an adult vitamin formulation. 

Salsalate is contraindicated in patients with known hypersensitivity to aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) and in the presence of gastrointestinal (GI) ulcer or GI bleeding because the drug may irritate the GI tract. It should be used cautiously in patients with hypothrombinemia, vitamin K deficiency, and bleeding disorders because of the potential for bleeding problems. 

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