MyMedR

As part of a large-scale international cooperative investigation into the side effects of thioacetazone-containing regimens in the treatment of tuberculosis, an evaluation has been made of the variation in the frequency of side effects between different countries and between different centres in the same country and of the likely reasons for this variation. In 3 countries patients of different racial origin were under observation in the same hospital. Over a 12-week period of treatment there was considerable variation between the countries and centres in the overall frequency of side effects and of those leading to a major departure from prescribed treatment, the variation being similar for the two thioacetazone-containing regimens and for the streptomycin plus isoniazid control regimen, though at a lower level for the latter. In Malaysia, Singapore, and Trinidad, where different racial groups were under treatment, there was no clear indication that race was an important factor in explaining the differences between countries, except for cutaneous side effects in Trinidad and possibly in Malaysia.It is concluded that the differences in the frequency of side effects to thioacetazone-containing regimens probably result from variation in the closeness of supervision of patients, in the recording and interpretation of side effects, and in environmental factors including the previous use of other medicaments or exposure to sensitizing substances.

Matched MeSH terms: Drug Hypersensitivity*

Collapse as a medical emergency

O'Holohan DR

Med J Malaysia, 1973 Jun;27(4):235-9.

PMID: 4270777

Matched MeSH terms: Drug Hypersensitivity*

Fulltext Hospital monitoring of adverse drug reactions in Singapore

Teoh PC

Singapore Med J, 1974 Dec;15(4):268-72.

PMID: 4458069

The serious health hazards posed by adverse drug reactions have long been recognised, but the application of epidemiological principles to their studies is only a recent development. A total of 3160 patients admitted into Medical Unit I, General Hospital, Singapore were kept under surveillance for adverse reactions to drugs for six months in 1972. Fifty three of them (1.7%) were admitted with adverse drug reactions as the sole reason for admission. There were 25 males and 28 females. There were two deaths and ten life-threatening reactions, and hypersensitivity was the most common type of reaction encountered. Among the chief offending drugs were Chinese herbal medicines, digoxin, corticosteroids, antibiotics, phenothiazines, and hypoglycaemic agents. All doctors especially the general practitioners must be fully aware of these hazards so that they can help prevent un- necessary morbidity and mortality and also to avoid taxing heavily on the already over-burdened hospital service in a developing country.

Matched MeSH terms: Drug Hypersensitivity/epidemiology*

Penicillin allergy 1976: a review of reactions, detection and current management

Fellner MJ

Int J Dermatol, 1976 Sep;15(7):497-504.

PMID: 134974

Matched MeSH terms: Drug Hypersensitivity/drug therapy; Drug Hypersensitivity/etiology*

Fulltext Suxamethonium sensitivity -- yet another case

Sivaneswaran N, Inbasegaran K

Med J Malaysia, 1982 Dec;37(4):298-9.

PMID: 7167078

Abnormal variants of plasma cholinesterase are a rarity in this region and to date there is only one reported case of suxamethonium sensitivity in a Malaysian population. We now report a case of a Malaysian Chinese patient who received suxamethonium, developed prolonged apnoea and on investigation found to be a homozygote for the silent gene. His family was screened for abnormal variants of plasma cholinesterase. The results are discussed.

Matched MeSH terms: Drug Hypersensitivity/genetics*

Hypersensitivity reaction to dapsone: report from Malaysia

Mohamed KN

Lepr Rev, 1984 Dec;55(4):385-9.

PMID: 6527602

Matched MeSH terms: Drug Hypersensitivity/etiology*

Mucosal sensitivity to chlorhexidine mouthwash

Yusof WZ, Khoo SP

Singapore Dent J, 1988 Dec;13(1):39-40.

PMID: 3155002

Mucosal sensitivity to chlorhexidine mouthwash is a rare occurrence and very few cases have been reported in the literature. The authors report 2 cases of oral sensitivity to chlorhexidine and discuss the side-effects, possible causes of sensitivity and the management of the cases.

Matched MeSH terms: Drug Hypersensitivity

The rubber elongation factor of rubber trees (Hevea brasiliensis) is the major allergen in latex

Czuppon AB, Chen Z, Rennert S, Engelke T, Meyer HE, Heber M, et al.

J Allergy Clin Immunol, 1993 Nov;92(5):690-7.

PMID: 8227860

BACKGROUND: Allergy to latex-containing articles is becoming more and more important because it can result in unexpected life-threatening anaphylactic reactions in sensitized individuals.

METHODS: A protein of 58 kd with an isoelectric point of 8.45 was purified from raw latex and from latex gloves and identified as the major allergen, completely blocking specific IgE antibodies in the serum of latex-sensitized subjects. The allergen is a noncovalent homotetramer molecule, in which the 14.6 kd monomer was identified, by amino acid composition and sequence homologies of tryptic peptides, to be the rubber elongation factor found in natural latex of the Malaysian rubber tree.

RESULTS: Competitive immunoinhibition tests showed that the starch powder covering the finished gloves is the airborne carrier of the allergen, resulting in bronchial asthma on inhalation. The purified allergen can induce allergic reactions in the nanogram range.

CONCLUSION: The identification of the allergen (Hev b I) may help to eliminate it during the production of latex-based articles in the future.

Matched MeSH terms: Drug Hypersensitivity/etiology; Drug Hypersensitivity/immunology*

Characterization of a monoclonal antibody against latex protein associated with latex allergy

Kurup VP, Kumar A, Kelly KJ, Fink JN

J Allergy Clin Immunol, 1993 Nov;92(5):638-43.

PMID: 8227854 DOI: 10.1016/0091-6749(93)90005-z

Several hybridomas were produced against antigens extracted from the latex sap of Hevea brasiliensis. One of the monoclonal antibodies (LA-E3) reacted with antigens demonstrating binding to patient sera on crossed enzyme immunoelectrophoresis. This monoclonal antibody reacted with 2 of 10 glove extracts studied and with both Malaysian and Indian latex plant extracts. The antigens purified with monoclonal antibody affinity chromatography demonstrated specific IgE in the sera of patients with latex allergy as determined by ELISA. This monoclonal antibody can thus be utilized to obtain reliable antigens useful in the diagnosis of latex sensitivity, although additional antigens will likely be necessary to enhance sensitivity and specificity.

Matched MeSH terms: Drug Hypersensitivity/etiology*

Natural rubber latex skin testing reagents: safety and diagnostic accuracy of nonammoniated latex, ammoniated latex, and latex rubber glove extracts

Hamilton RG, Adkinson NF

J Allergy Clin Immunol, 1996 Nov;98(5 Pt 1):872-83.

PMID: 8939150

BACKGROUND: Nonammoniated latex, ammoniated latex, and rubber glove extracts are the only sources of natural rubber (Hevea brasiliensis) latex that have potential for use as skin testing reagents in the diagnosis of latex allergy. Their diagnostic sensitivity and specificity as skin test reagents are unknown.

OBJECTIVE: We conducted a phase 1/2 clinical study to examine the safety and diagnostic accuracy (sensitivity and specificity) of nonammoniated latex, ammoniated latex, and rubber glove extracts as skin test extracts to identify the most efficacious source material for future skin test reagent development.

METHODS: Twenty-four adults not allergic to latex, 19 adults with hand dermatitis or pruritus, and 59 adults with a latex allergy were identified by clinical history. All provided blood and then received puncture skin tests and intradermal skin tests with nonammoniated latex, ammoniated latex, and rubber glove extracts from Malaysian H. brasiliensis latex by use of sequential titration. A glove provocation test and IgE anti-latex RAST were used to clarify positive history-negative skin test response and negative history-positive skin test response mismatches.

RESULTS: All three extracts were biologically safe and sterile. After normalization to 1 mg/ml of total protein, all three extracts produced equivalent diagnostic sensitivity and specificity in puncture skin tests and intradermal skin tests at various extract concentrations. Optimal diagnostic accuracy was safely achieved at 100 micrograms/ml for intradermal skin tests (e.g., nonammoniated latex: puncture skin test sensitivity 96%, specificity 100%; intradermal skin test sensitivity 93%, specificity 96%). The presence of IgE antibody in skin was highly correlated with IgE anti-latex in serum (nonammoniated latex: r = 0.98, p < 0.001; ammoniated latex: r = 0.94, p < 0.001; rubber glove extract: r = 0.96, p < 0.001). All five available subjects with a positive history, negative skin test response, and absence of IgE antibody in serum had a negative glove provocation test response, indicating no clinical evidence of latex allergy. No systemic or large local allergic reactions were observed with puncture skin tests or intradermal skin tests.

CONCLUSIONS: Equivalent diagnostic sensitivity and specificity were observed with the nonammoniated latex, ammoniated latex, and rubber glove extract skin test reagents after normalization for total protein; nonammoniated latex may be considered the reagent of choice on the basis of practical quality control and reproducibility considerations.

Matched MeSH terms: Drug Hypersensitivity/diagnosis*; Drug Hypersensitivity/immunology

Fulltext Prevalence of latex hypersensitivity among health care workers in Malaysia

Shahnaz M, Azizah MR, Hasma H, Mok KL, Yip E, Ganesapillai T, et al.

Med J Malaysia, 1999 Mar;54(1):26-31.

PMID: 10972001

Health care workers have been reported to constitute one of the few high-risk groups related to IgE-mediated hypersensitivity associated with the use of latex products. This paper describes the first ever study of prevalence carried out in Malaysia among these workers. One hundred and thirty health care personnel from Hospital Kuala Lumpur were skin tested. Extracts used were prepared from seven different brands of natural rubber latex gloves with varying levels of extractable protein (EPRRIM). Out of the 130 volunteers, 4 (3.1%) had positive skin test to latex with extracts with high levels of EPRRIM (> 0.7 mg/g). The prevalence among the Malaysian health care workers can be considered to be low in comparison to that of some consumer countries as the USA which reported a prevalence of as high as 16.9%.

Matched MeSH terms: Drug Hypersensitivity/epidemiology*

Hypersensitivity reactions to high-dose co-trimoxazole in HIV-infected Malaysian and Scottish patients

Pakianathan MR, Kamarulzaman A, Ismail R, McMillan A, Scott GR

AIDS, 1999 Sep 10;13(13):1787-8.

PMID: 10509585

Matched MeSH terms: Drug Hypersensitivity/ethnology; Drug Hypersensitivity/etiology*

Red man syndrome during administration of prophylactic antibiotic against infective endocarditis

Ngeow WC, Chai WL, Moody AB

J Ir Dent Assoc, 2000;46(3):92-4.

PMID: 11323942

Red man syndrome (RMS) is the occurrence flushing, pruritus, chest pain, muscle spasm or hypotension during vancomycin infusion. It usually happens as a result of rapid infusion of the drug but may also occur after slow administration. The frequency and severity of this phenomenon diminish with repeated administration of vancomycin. A case is presented whereby RMS occurred while prophylactic antibiotic against infective endocarditis was administered.

Matched MeSH terms: Drug Hypersensitivity/etiology*

Hypersensitivity reactions to oxaliplatin in two asian patients

Ng CV

Ann Pharmacother, 2005 Jun;39(6):1114-8.

PMID: 15886290

To report 2 cases of hypersensitivity reactions associated with oxaliplatin treatment in Asian patients.

Matched MeSH terms: Drug Hypersensitivity/ethnology; Drug Hypersensitivity/etiology*; Drug Hypersensitivity/prevention & control

Molecular cloning and immunoglobulin E reactivity of a natural rubber latex lecithinase homologue, the major allergenic component of Hev b 4

Sunderasan E, Bahari A, Arif SA, Zainal Z, Hamilton RG, Yeang HY

Clin Exp Allergy, 2005 Nov;35(11):1490-5.

PMID: 16297147 DOI: 10.1111/j.1365-2222.2005.02371.x

BACKGROUND:
Hev b 4 is an allergenic natural rubber latex (NRL) protein complex that is reactive in skin prick tests and in vitro immunoassays. On SDS-polyacrylamide gel electrophoresis (SDS-PAGE), Hev b 4 is discerned predominantly at 53-55 kDa together with a 57 kDa minor component previously identified as a cyanogenic glucosidase. Of the 13 NRL allergens recognized by the International Union of Immunological Societies, the 53-55 kDa Hev b 4 major protein is the only candidate that lacks complete cDNA and protein sequence information.

OBJECTIVE:
We sought to clone the transcript encoding the Hev b 4 major protein, and characterize the native protein and its recombinant form in relation to IgE binding.

METHODS:
The 5'/3' rapid amplification of cDNA ends method was employed to obtain the complete cDNA of the Hev b 4 major protein. A recombinant form of the protein was over-expressed in Escherichia coli. The native Hev b 4 major protein was deglycosylated by trifluoromethane sulphonic acid. Western immunoblots of the native, deglycosylated and recombinant proteins were performed using both polyclonal antibodies and sera from latex-allergic patients.

RESULTS:
The cDNA encoding the Hev b 4 major protein was cloned. Its open reading frame matched lecithinases in the conserved domain database and contained 10 predicted glycosylation sites. Detection of glycans on the Hev b 4 lecithinase homologue confirmed it to be a glycoprotein. The deglycosylated lecithinase homologue was discerned at 40 kDa on SDS-PAGE, this being comparable to the 38.53 kDa mass predicted by its cDNA. Deglycosylation of the lecithinase homologue resulted in the loss of IgE recognition, although reactivity to polyclonal rabbit anti-Hev b 4 was retained. IgE from latex-allergic patients also failed to recognize the non-glycosylated E. coli recombinant lecithinase homologue.

CONCLUSION:
The IgE epitopes of the Hev b 4 lecithinase homologue reside mainly in its carbohydrate moiety, which also account for the discrepancy between the observed molecular weight of the protein and the value calculated from its cDNA.

Matched MeSH terms: Drug Hypersensitivity/immunology

Clinical experience in using CD20 monoclonal antibody in treating severe systemic lupus erythematosus

Mohd Shahrir MS, Abdul Halim AG, Soehardy Z, Kong NCT

APLAR Journal of Rheumatology, 2007;10(2):112-116.

DOI: 10.1111/j.1479-8077.2007.00270.x

Background and method: This clinical experience involved the treatment of resistant systemic lupus erythematosus (SLE) patients with CD20 monoclonal antibody. Five patients failed conventional therapy, two developed complications and one needed rituximab as an emergency measure. Four patients had lupus nephritis, three had autoimmune hemolytic anemia, two had immune thrombocytopenia and one had lupoid hepatitis. The patients were aged 14-49 years, (mean 28.63). Three were Malays, two Chinese, two Indian and one Turkish; six were females. Mean disease duration was 63.25 months and mean total rituximab dose received was 2812.50 mL. Results: Hemoglobin levels improved from 9.3 ± 5.7 to 13.1 ± 8.6 g/dL for two SLE patients with autoimmune hemolytic anemia after 34 weeks (P = 0.180). Platelet counts improved from 25 ± 17 to 198 ± 97 × 10 9/high powered field from 0 to 10 weeks for three SLE patients with immune thrombocytopenia (P = 0.109). In the lupus nephritis patients on rituximab, serum albumin improved from 24.5 ± 23.2 to 37.5 ± 31.8 mmol/L (n = 3) from week 0 to week 17 (P = 0.100). Urine protein creatinine ratio improved from 0.55 ± 0.23 to 0.08 ± 0.03 g/mmol creatinine (P = 0.068) from week 0 to week 13. C3 and C4 improved from 90.8 ± 36.5 to 120.7 ± 37.9 (P = 0.07) and 21.6 ± 10.1-27.3 ± 16.2 mg/dL (P = 0.27), respectively, and Systemic Lupus Erythematosus Activity Disease Index was reduced from 17.9 ± 11.2 to 6.3 ± 6.8 (P = 0.375) after 8 weeks. Two patients developed drug reactions to rituximab. Conclusion: All of the patients responded to rituximab on top of their conventional therapy. © 2007 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

Matched MeSH terms: Drug Hypersensitivity

Fulltext Dapsone syndrome--first Malaysian paediatric case report

Zurina Z, Elizawaty O, Thevarajah S, Norlijah O

Med J Malaysia, 2012 Feb;67(1):105-7.

PMID: 22582558

Dapsone syndrome is a potentially fatal hypersensitivity reaction to sulphone. We report a 12-year-old girl who developed high grade fever associated with intense jaundice, exfoliative skin rash and hepatomegaly after five weeks of starting the multidrug regimen for the treatment of Hansen's disease. Laboratory investigations revealed presence of leucocytosis with eosinophilia, deranged liver enzymes and an abnormal coagulation profile. Immediate cessation of the offending drug and administration of steroid proved successful. A high level of clinical awareness is fundamental for early diagnosis of dapsone syndrome as initiation of a prompt treatment may lead to rapid recovery.

Matched MeSH terms: Drug Hypersensitivity/diagnosis*

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