Angioedema ; Asthma ; Classification ; Diagnosis ; Drug Hypersensitivity ; Humans ; Hypersensitivity ; Phenotype ; Rhinitis ; Urticaria

No abstract available.
Angioedema ; Eosinophilia

Urticaria is a common cutaneous disease characterized by recurrent and transient wheals and pruritus, sometimes accompanied angioedema. The classification of urticaria is based on the duration of the disease and whether extrinsic triggers are identified or not. Acute urticaria is usually occurred by specific causes, such as drug, food, and infection, etc. Therefore, acute urticaria can be remitted within 6 weeks just by avoiding the exposure to the causes. However, chronic urticaria defined as repeatedly occurred itchy wheals and/or angioedema for at least 6 weeks, has a significant effect on patients' quality of life. Chronic inducible urticaria can be triggered by various physical stimuli including dermographism, delayed pressure, cold, heat, cholinergic stimuli, sunlight, and exercise. Chronic spontaneous urticaria (CSU) is diagnosed when no specific extrinsic cause is identified in the patients. CSU due to autoimmune mechanism accounts for 30–50%, autologous serum skin test and anti-thyroid autoantibody can be evaluated. However, various physical stimuli, emotional or physical stress, drugs, particularly aspirin and non-steroidal anti-inflammatory drugs can exacerbate urticaria in 30–75% of patients with CSU. Allergic diseases and autoimmune diseases are more common in CSU patients than in general populations. To assess the severity of urticaria and to adjust treatment step, urticaria activity score over 7 days, calculated by the number of wheals and the severity of pruritus, is recommended by recent international guidelines.
Angioedema ; Aspirin ; Autoimmune Diseases ; Classification ; Diagnosis ; Hot Temperature ; Humans ; Pruritus ; Quality of Life ; Skin Tests ; Sunlight ; Urticaria

Chronic spontaneous urticaria (CSU) is characterized by typically short-lived and fleeting wheals, angioedema or both, which occur spontaneously and persist for longer than 6 weeks. This term is applied to the most common subtype of chronic urticaria. The underlying pathophysiology for CSU involves mast cell and basophil degranulation with release of histamine, leukotrienes, prostaglandins and other inflammatory mediators. Although a variety of treatments exist, many patients do not tolerate or benefit from the existing therapies and even require more effective treatments. Omalizumab is currently the only licensed biologic for antihistamine-refractory CSU, and novel drugs are under development. This article reviews its current status regarding pathogenesis and approach to treatment as well as therapeutic agents that are under development for the treatment of CSU.
Angioedema ; Basophils ; Biological Products ; Histamine ; Humans ; Leukotrienes ; Mast Cells ; Omalizumab ; Prostaglandins ; Urticaria

Skin diseases associated with athletic activities can be classified as skin infections, inflammatory reactions, trauma, and abnormal proliferation, depending on the cause of the condition. Athlete's nodule is a generic term for reactive nodules that occur in athletes. It is particularly common in the foot due to tight sneakers, repetitive pressure or friction, and inappropriate choice of shoes or other sports equipment. The diagnosis of black heel (calcaneal petechiae) should be considered when numerous black spots occur on the soles in patients who frequently engage in abrupt movements, such as starts, stops, or leaps. Palmoplantar eccrine hidradenitis may occur in athletes who play baseball, dance, and climb, activities in which repetitive and strong stimuli are applied to the floor of the hands and feet. Painful fat herniation should be suspected in cases of painful skin-colored firm nodules on the feet of athletes who place a large amount of weight on their feet when moving. Itching, urticaria, angioedema, chest tightness, and syncope occurring within 5 minutes after starting exercise should be suspected to be exercise-induced angioedema/anaphylaxis. Excessive force can cause deformation of nails, as in tennis toe and jogger's toenail. For the diagnosis and treatment of sports-related skin diseases, it is essential to pay attention to patients' hobbies and exercise habits, including sports, and to consider the relationship of those habits with the presumed mechanisms of the skin disease. In addition, thorough pre-exercise warm-ups, increasing strength gradually, and wearing proper equipment will help prevent the occurrence of sports-related skin diseases.
Angioedema ; Athletes ; Baseball ; Dancing ; Diagnosis ; Foot ; Friction ; Hand ; Heel ; Hidradenitis ; Hobbies ; Humans ; Nails ; Pruritus ; Shoes ; Skin Diseases ; Skin ; Sports ; Sports Equipment ; Syncope ; Tennis ; Thorax ; Toes ; Urticaria

PURPOSE: Eperisone is an oral muscle relaxant used in musculoskeletal disorders causing muscle spasm and pain. For more effective pain control, eperisone is usually prescribed together with nonsteroidal anti-inflammatory drugs (NSAIDs). As such, eperisone may have been overlooked as the cause of anaphylaxis compared with NSAIDs. This study aimed to analyze the adverse drug reaction (ADR) reported in Korea and suggest an appropriate diagnostic approach for eperisone-induced anaphylaxis. METHODS: We reviewed eperisone-related pharmacovigilance data (Korea Institute of Drug Safety-Korea Adverse Event Reporting System [KIDS-KAERS]) reported in Korea from 2010 to 2015. ADRs with causal relationship were selected. Clinical manifestations, severity, outcomes, and re-exposure information were analyzed. For further investigation, 7-year ADR data reported in a single center were also reviewed. Oral provocation test (OPT), skin prick test (SPT) and basophil activation test (BAT) were performed in this center. RESULTS: During the study period, 207 patients had adverse reactions to eperisone. The most common ADRs were cutaneous hypersensitive reactions (30.4%) such as urticaria, itchiness or angioedema. Fifth common reported ADR was anaphylaxis. There were 35 patients with anaphylaxis, comprising 16.9% of the eperisone-related ADRs. In the single center study, there were 11 patients with eperisone-induced anaphylaxis. All the patients underwent OPT and all the provoked patients showed a positive reaction. Four of the 11 patients with anaphylaxis also underwent SPT and BAT, which were all negative. CONCLUSIONS: Incidence of eperisone-induced anaphylaxis calculated from the KIDS-KAERS database was 0.001%. Eperisone can cause hypersensitive reactions, including anaphylaxis, possibly by inducing non-immunoglobulin E-mediated immediate hypersensitivity.
Anaphylaxis ; Angioedema ; Anti-Inflammatory Agents, Non-Steroidal ; Basophils ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Incidence ; Korea ; Pharmacovigilance ; Skin ; Spasm ; Urticaria

Intraoperative bovine-derived topical thrombin is still widely used for hemostasis during surgery. A 38-year-old woman with chronic spontaneous urticaria was referred to the orthopedic surgery department for herniated disk and myelopathy. During the first stage of operation, bovine-derived thrombin powder soaked in Gelfoam was used as a hemostatic aid. After 30 minutes, the patient developed anaphylactic shock with systemic skin rash and angioedema. Repeated intravenous bolus and infusion of vasopressor were carried out, and her blood pressure normalized. Skin test and specific immunoglobulin E test showed positive results for bovine thrombin and beef, respectively. During the second stage of operation (After 10 days from first stage of operation), bovine-derived thrombin powder was excluded and the operation was successful without any unexpected events. Therefore, bovine thrombin should be used with caution because it might cause anaphylaxis.
Adult ; Anaphylaxis* ; Angioedema ; Blood Pressure ; Exanthema ; Female ; Gelatin Sponge, Absorbable ; Hemostasis ; Humans ; Immunoglobulin E ; Immunoglobulins ; Intervertebral Disc Displacement ; Orthopedics ; Red Meat ; Skin Tests ; Spinal Cord Diseases ; Thrombin* ; Urticaria

The efficacy and the adverse effects of intravenous iron formulas have been well established. However, there are few reports of anaphylaxis of ferric carboxymaltose (FCM). A man received intravenous FCM for the treatment of restless legs syndrome. The FCM gave rise to angioedema, urticaria, chest tightness, sinus tachycardia, and hypotension. In the end, epinephrine and dexamethasone resolved the symptoms. The findings were consistent with anaphylactic hypersensitivity reaction from FCM. We need to be careful when we administer FCM in clinics.
Anaphylaxis ; Angioedema ; Dexamethasone ; Epinephrine ; Hypersensitivity ; Hypotension ; Iron ; Restless Legs Syndrome ; Tachycardia, Sinus ; Thorax ; Urticaria

Pyrazinamide (PZA) is an anti-tuberculosis drug and an essential component of the standard four-drug regimen for tuberculosis. Here, we report a case of immediate angioedema secondary to PZA administration intended for pulmonary tuberculosis treatment. A previously healthy 48-year-old woman was diagnosed with pulmonary tuberculosis and tuberculous lymphadenitis. Thirty minutes after taking the first dose of isoniazid, rifampicin, pyrazinamide, and ethambutol, the patient developed facial edema, generalized rash, and dizziness. An oral provocation test was performed on the four drugs, and 1,000 mg pyrazinamide showed a positive result characterized by 50 minutes of urticaria, angioedema, and hypotension. As the prevalence of tuberculosis increases, prescriptions for anti-tuberculosis drugs may increase as well. Clinicians should be aware of the possibility of immediate hypersensitivity as well as delayed hypersensitivity to anti-tuberculosis drugs.
Angioedema* ; Dizziness ; Drug Hypersensitivity ; Edema ; Ethambutol ; Exanthema ; Female ; Humans ; Hypersensitivity, Delayed ; Hypersensitivity, Immediate ; Hypotension ; Isoniazid ; Middle Aged ; Prescriptions ; Prevalence ; Pyrazinamide ; Rifampin ; Tuberculosis ; Tuberculosis, Lymph Node ; Tuberculosis, Pulmonary ; Urticaria*

PURPOSE: Drug provocation tests (DPT) are the gold standard for confirming the diagnosis of drug hypersensitivity reactions (DHRs). However, there are little studies of DPT in children. The purpose of this study was to evaluate DPT results and safety as diagnostic methods of DHR in Korean children. METHODS: We reviewed the medical records of 39 children under 18 years of age with a suspected DHR and performed DPT between January 2010 and May 2016 at Asan Medical Center. RESULTS: Total 110 DPT were performed in 39 children (20 boys and 19 girls) with a history of DHR. Clinical presentation of DHR included skin rash (n=7), pruritus (n=3), urticaria (n=18), angioedema (n=19), dyspnea (n=5), hoarseness (n=1), hypothermia (n=1), and anaphylaxis (n=5). The median age at the time of DPT was 9 years. Positive DPT were observed in 21 of 39 children (53.8%) and 28 of 110 cases (25.5%). Drugs causing positive reactions were acetaminophen in 50% (9 of 18), nonsteroidal anti-inflammatory drugs in 29.2% (14 of 48), cephalosporin in 9.1% (1 of 11), trimethoprim/sulfamethoxazole in 50% (1 of 2), local anesthetics in 10% (1 of 10), and others (levodropropizine and idursulfase) in 15.4% (2 of 13). There was no statistical difference between children who had positive and negative results in sex, age, personal and parental history of allergic disease, eosinophil count, or total IgE level. Children with positive DPT did not develop anaphylaxis during the DPT procedure. CONCLUSION: Drug provocation test is safe, and it can be considered in children with suspected DHRs.
Acetaminophen ; Anaphylaxis ; Anesthetics, Local ; Angioedema ; Child ; Chungcheongnam-do ; Diagnosis ; Drug Hypersensitivity ; Dyspnea ; Eosinophils ; Exanthema ; Hoarseness ; Humans ; Hypothermia ; Immunoglobulin E ; Medical Records ; Parents ; Pruritus ; Urticaria