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Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most frequent causes of drug hypersensitivity reactions, affecting 1%-3% of general population; the prevalence of NSAID hypersensitivity is higher in patients with chronic rhinosinusitis, nasal polyposis, asthma, or chronic urticaria, affecting up to 30% of patients[1]. This is a prospective, real-life, observational study aimed to evaluate all direct and indirect health costs of patients that consulted in our outpatient clinic for suspected NSAID hypersensitivity reactions. One of the advantages of performing a study of NSAID hypersensitivity is de-labeling of purported NSAID hypersensitivity patients. [Extracted from the article]

Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%‐3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re‐exposition or drug provocation test should only be done with skin test‐negative ICMs. The decision for performing either re‐exposition or drug provocation test needs to be taken based on a risk‐benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial. [ABSTRACT FROM AUTHOR]

In humans, mRNA polyadenylation involves the participation of about 20 factors in four main complexes that recognize specific RNA sequences. Notably, CFIm25, CPSF73, and PAP have essential roles for poly(A) site selection, mRNA cleavage, and adenosine residues polymerization. Besides the relevance of polyadenylation for gene expression, information is scarce in intestinal protozoan parasites that threaten human health. To better understand polyadenylation in Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum, which represent leading causes of diarrhea worldwide, genomes were screened for orthologs of human factors. Results showed that Entamoeba histolytica and C. parvum have 16 and 12 proteins out of the 19 human proteins used as queries, respectively, while G. lamblia seems to have the smallest polyadenylation machinery with only six factors. Remarkably, CPSF30, CPSF73, CstF77, PABP2, and PAP, which were found in all parasites, could represent the core polyadenylation machinery. Multiple genes were detected for several proteins in Entamoeba, while gene redundancy is lower in Giardia and Cryptosporidium. Congruently with their relevance in the polyadenylation process, CPSF73 and PAP are present in all parasites, and CFIm25 is only missing in Giardia. They conserve the functional domains and predicted folding of human proteins, suggesting they may have the same roles in polyadenylation. [ABSTRACT FROM AUTHOR]

Drug hypersensitivity reactions (DHRs) are nowadays the third cause of allergy after rhinitis and asthma with a significant increase in prevalence in both adults and paediatric population with new drugs included as culprit. For this, DHRs represent not only a health problem but also a significant financial burden for affected individuals and health systems. Mislabelling DHRs is showing to be a relevant problem for both, false label of drug allergic and false label of nonallergic. All this reinforces the need to improve accurate diagnostic approaches that allow an appropriate management. Moreover, there is a need for training both, nonallergist stakeholders and patients to improve the reaction identification and therefore decrease the mislabelling. The use of allergy cards has shown to be relevant to avoid the induction of DHRs due to the prescription of wrong medication. Recent developments over the last 2 years and highlights about risk factors, diagnostic approaches, mechanisms involved as well as prevention actions, and management have been reviewed. In these papers, it has been outlined the need for correct diagnosis and de‐labelling of patients previously false‐reported as allergic, which will improve the management and treatment of patients with DHRs. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 71-year-old white woman presented with non-follicular pustules on oedematous erythema. Topics discussed include diagnosed with acute generalized exanthematous pustulosis (AGEP) from azithromycin and treated with clobetasol and loratadine, antibiotics as main triggering drugs of AGEP such as macrolides and pristinamycin and tolerance to clarithromycin suggesting the reaction as selective for azithromycin with no cross-reactivity with other macrolides.

Abbreviations AGEP acute generalized exanthematous pustulosis BAT basophil activation test CI cross-intolerant CSU chronic spontaneous urticarial DIHS/DRESS drug-induced hypersensitivity syndrome/drug reaction eosinophilia and systemic symptoms FDE fixed drug eruption LTT lymphocyte transformation test MPE maculopapular exanthema NECD exacerbated cutaneous disease NERD NSAIDs-exacerbated respiratory disease NIUA NSAIDs-induced urticaria/angioedema NSAIDs nonsteroidal anti-inflammatory drugs SJS Steven-Johnson syndrome SNIDHRs single-NSAID-induced delayed hypersensitivity reactions SNIUAA single-NSAID-induced urticaria/angioedema and anaphylaxis SR selective responders TEN toxic epidermal necrolysis Diagnosis in suspected hypersensitivity reactions to nonsteroidal anti-inflammatory drugs (NSAIDs) is complex as different mechanisms are involved: specific (selective responders, SRs) and nonspecific immunologically mediated (cross-intolerants, CIs) [[1], [3]] (Table). Patients with repeated episodes to >=3 different NSAIDs, including a strong COX-1 inhibitor, may be diagnosed as CIs.[4] The symptomatology after NSAIDs intake and the underlying diseases lead to their precise diagnosis: NSAIDs-exacerbated respiratory disease (NERD), NSAIDs-exacerbated cutaneous disease (NECD), NSAIDs-induced urticaria/angioedema (NIUA), and blended reactions (Figure, Table).[[1], [5]] If <3 episodes to different NSAIDs are reported, challenge tests are recommended to confirm/exclude the CI diagnosis; except if reactions involve airways in patients with underlying chronic respiratory disorders in which NERD diagnosis can be made by clinical history without performing challenge.[6] After diagnosis confirmation, a challenge to find a safe alternative is required (Figure). In vitro tests for drug hypersensitivity reactions: an ENDA/EAACI drug allergy interest group position paper. [Extracted from the article]

The article presents a case study of a 66-year-old female who developed fixed drug eruption (FDE) after taking etoricoxib. Plaques disappeared in a week without being treated but left hyperpigmented lesions. Patch tests were conducted involving etoricoxib and celecoxib. Results indicate an erythematous papular reaction on skin areas administered with etoricoxib. The relation of developing FDE, which is a variant of drug-induced dermatosis, with etoricoxib use is mentioned.

Aim To evaluate the reliability of two techniques of cervical ripeness assessment at the beginning of labor induction, as assessed by inexperienced observers. Methods A total of 120 women were prospectively studied at admission for labor induction. Two independent physicians examined consenting women successively but separately. One experienced consultant and one of the six first-year obstetrics residents composed the pairs of observers. The trainees had very limited prior experience with cervical ultrasound scan or evaluating Bishop score. Cervical length and Bishop score were evaluated according to standard methodology. Reliability was described by intraclass correlation coefficients ( ICC) and coefficients of variation ( COV). Ultrasound cervical length was plotted according to the Bland- Altman method. Results The median Bishop score and mean cervical length were similar for all observers. Ultrasound cervical length and Bishop score were highly reliable when evaluated by first-year residents. Ultrasound cervical length showed the highest interobserver agreement, with ICC values over 0.9 and COV values of approximately 10% or less for all trainees. The Bishop score was also reliable, but with lower ICC and higher COV values. Conclusion Bishop score and ultrasound cervical length examination for the management of labor induction are accurate and easy to learn by inexperienced first-year residents. However, cervical length showed higher reliability than the Bishop score. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 74-yr-old woman who was diagnosed with Gerstmann-Sträussler-Scheinker (GSS) disease after undergoing a magnetic resonance imaging procedure. The diagnosis of atypical parkinsonism was first ruled out after the patient showed atypical clinical signs for Parkinson's disease (PD). The medical conditions detected upon the patient's hospital admission include blepharospasm, freezing of gait and cognitive impairment.

In this study, we developed a quantitative method with digital image analysis to evaluate the degree of gingival overgrowth (GO). and compared GO in kidney transplant patients treated with cyclosporin A (CsA) (n=21) or CsA-nifedipine (n=8) and a group of healthy controls (n=30). The method was reproducible and reliable. Our findings showed significant differences in papillary and gingival surface between controls and transplant patients treated with GO inducers. Gingival overgrowth index also differed significantly between controls and each patient group (p<0.01, Kruskal-Wallis test). The administration of the calcium channel blocker nifedipine potentiated the adverse effect of CsA: comparison of the morphometric findings revealed significant differences between patients treated with CsA alone and CsA 1 nifedipine in papillary area, dental area, and GO index (p<0.01, Mann-Whitney U-test). We conclude that the method of image analysis we developed is useful in assessing the degree of GO. [ABSTRACT FROM AUTHOR]