Explore the vast range of titles available.

Paclitaxel is one of the first-line treatments for breast, ovarian, and lung cancers. However, its use is limited by the high frequency of hypersensitivity reactions. In this retrospective chart review at Memorial Sloan Kettering Cancer Center, we assess clinical factors associated with immediate and delayed hypersensitivity reactions to paclitaxel and characterize delayed hypersensitivity reactions to paclitaxel in patients with breast cancer. 12,274 patients were treated with paclitaxel. 6,165 had breast cancer and 1,233 were seen by a dermatologist. 734 patients (11.9%) developed an immediate hypersensitivity reaction. Age ( p  < 0.001), race ( p  < 0.001), and prior history of allergy ( p  = 0.05) were associated with immediate hypersensitivity reactions. 147 patients (4.0%) had a rash of interest. The most common phenotypes were maculopapular (52%) and urticaria (36%). Race ( p  < 0.001) and history of allergy ( p  < 0.001) were associated with development of a cutaneous reaction. Patients with an immediate hypersensitivity reaction were more likely to have developed a delayed cutaneous reaction (OR = 1.80). Risk factors for development of immediate hypersensitivity reactions in this study were younger age, race, and history of allergy. Patients who developed an immediate hypersensitivity reaction were more likely to develop a delayed hypersensitivity reaction. Risk factors for development of the rash included Asian race and history of allergy. Identification of risk factors is critical to guide care coordination. Awareness of these clinical factors which are associated with development of a rash could guide providers in choosing treatment with paclitaxel or nab-paclitaxel. If the cutaneous reactions are bothersome to the patient, the transition of treatment from paclitaxel to nab-paclitaxel may be warranted, or a consideration of re-challenge or desensitization may be discussed.

ObjectivesWhile hypersensitivity reactions (HSR) to intravenously administered iodinated contrast media (ICM) have been well studied, not much is known about HSR to intra-arterially administered ICM.MethodsA prospective observational study was performed to evaluate coronary angiography (CAG)-induced ICM hypersensitivity in patients who underwent CAG using ICM including ioversol, a low-osmolar non-ionic monomer, and iodixanol, an iso-osmolar non-ionic dimer. The HSR were investigated through in-patient monitoring after CAG and telephone interview after discharge.ResultsA total of 714 patients were enrolled during the observation period, of whom 26 (3.6%) showed immediate HSR and 108 (15.1%) showed delayed HSR. With regard to severity, proportion of immediate HSR grades 1, 2, and 3 was 57.7%, 38.5%, and 3.8%, respectively, whereas that of delayed HSR grades 1, 2, and 3 was 85.2%, 13.9%, and 0.9%, respectively. Multivariate analysis revealed that previous intra-arterial exposure to ICM was an independent risk factor for immediate HSR (odds ratio (OR) 2.92, 95% confidence interval (CI) 1.22–6.96; p = 0.015). Iodixanol was a significant risk factor for delayed HSR (OR 1.61, 95% CI 1.07–2.43; p = 0.024) and correlated with a higher incidence of delayed HSR within 24-h post-ICM administration compared to ioversol.ConclusionThe incidence rate of immediate and delayed HSR in intra-arterially administered ICM was 3.6% and 15.1%, respectively. Previous exposure to intra-arterially administered contrast media was a significant risk factor for immediate HSR. Compared to ioversol, iodixanol was associated with relatively earlier and more frequent delayed HSR.Key Points• In this prospective study, the incidence of immediate and delayed hypersensitivity in intra-arterial injection of contrast media during coronary angiography was 3.6% and 15.1%, respectively.• Delayed hypersensitivity reactions were more common but less severe than immediate hypersensitivity reactions during coronary angiography.• Previous exposure to ICM via intra-arterial route was a significant risk factor for immediate hypersensitivity to intra-arterial contrast medium.

PurposeThe occurrence of a hypersensitivity reaction with the injection of botulinum toxin type A (BTX-A) in cosmetic use is a rare complication. We report the largest case series of temporary delayed hypersensitivity reaction (DHR) with BTX-A following COVID-19 vaccination and the first cases to incobotulinum toxin A (incoBTX-A).MethodsA retrospective multicentric case series of patients who developed a DHR to BTX-A after COVID-19 vaccination.ResultsTwelve patients were treated with BTX-A injections for the management of facial rhytids. The age range was between 29 and 45 years. Ten (83.3%) were female. Ten (83.3%) patients received incoBTX-A, and two received onabotulinum toxin A (onaBTX-A). All patients had COVID-19 vaccination (mRNA vaccine) between 1 and 7 months before. Within an average time of 24 h after BTX-A injection, all patients developed progressive facial swelling and erythema that were more prominent at the injection points. Intradermal allergic tests to BTX-A were performed in six (50%) patients, and the results were all negative. Adequate clinical control was achieved with systemic corticosteroids and antihistamines. After 1 year with no further vaccination, a new BTX-A treatment (provocation test) was performed in all patients with no secondary effects.ConclusionPrevious COVID-19 vaccination and the absence of new adverse events with further BTX-A injections suggest a temporary DHR. Clinicians should be aware of the importance of immunization history and its potential post-vaccine immunogenic effects with BTX-A.Level of Evidence IVThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authorswww.springer.com/00266 .

Key Points Describes the history of chlorhexidine use in medicine and dentistry. Highlights the spectrum of reported hypersensitivity reactions to chlorhexidine. Reports two cases of death due to anaphylaxis following the use of chlorhexidine in post-extraction tooth socket care. Immunological reactions to chlorhexidine, including allergy (Type I hypersensitivity) and allergic contact dermatitis/stomatitis (Type IV hypersensitivity), have been recognised for many years. This potential safety issue, however, is not well known within dentistry. The purpose of this paper is to alert dentists and dental care professionals to the potential of chlorhexidine in causing hypersensitivity reactions and to consider this possibility if unexplained hypersensitivity reactions occur.

Background Vancomycin-induced delayed hypersensitivity reactions are rare and typically accompanied by systemic symptoms such as fever, eosinophilia, and organ dysfunction, known as drug reaction with eosinophilia and systemic symptoms syndrome. However, nonsteroidal anti-inflammatory drugs can mask typical systemic signs, complicating diagnosis. Case presentation A 61-year-old Asian Taiwanese male patient developed widespread erythematous macules and papules, significant skin desquamation, pruritus, and eosinophilia after 25 days of vancomycin therapy initiated for suspected methicillin-resistant Staphylococcus aureus (MRSA)-related spondylodiscitis. Notably, the patient remained afebrile, likely owing to concurrent prolonged aceclofenac (nonsteroidal anti-inflammatory drug) usage, which masked the fever commonly associated with hypersensitivity reactions. Symptoms improved significantly after discontinuing vancomycin and initiating antihistamines and corticosteroid therapy. Conclusion This case highlights an atypical presentation of vancomycin-induced delayed hypersensitivity with incomplete drug reaction with eosinophilia and systemic symptoms syndrome due to the absence of fever, potentially masked by nonsteroidal anti-inflammatory drug treatment. Clinicians should remain vigilant for atypical presentations of drug hypersensitivity reactions, especially in patients concurrently taking nonsteroidal anti-inflammatory drugs that can suppress fever.

One of the most commonly used local anesthetic (LA) agents in dentistry is lidocaine. Hypersensitivity reactions to lidocaine have been reported. In such cases, it is crucial to record a detailed clinical history and perform allergy testing to select a suitable alternative LA agent. This report presents the experience of observing a case of lidocaine allergy, supported by a review of the literature on the condition. A rare case of delayed hypersensitivity reaction to lidocaine is reported, where the patient exhibited swelling and erythema of the upper labial mucosa. Intradermal testing confirmed an allergic reaction to lidocaine. The patient was successfully treated with an alternative LA agent, allowing for the completion of dental procedures without complications. This highlights the importance of careful diagnostic measures to manage such rare but significant allergic reactions effectively. This case highlights the importance of recording a proper clinical history and performing allergy testing before the administration of LA to prevent severe allergic reactions. Additionally, patients identified as allergic to LA agents should be thoroughly counseled, informed about their condition, and provided with a clear explanation of all available treatment options

ABSTRACT Background Soft tissue filler injection is the second most commonly performed cosmetic procedure worldwide, with augmentation rhinoplasty being the most common filling surgery in Asian countries because Asians predominantly have a low nasal bridge. With the increasing pursuit of beauty, the adverse reactions after injection not only damage the patient's appearance but also greatly affect their quality of life. Therefore, exploring effective methods to address adverse reactions after nasal filler injections is necessary. Aims Herein, we aimed to explore safe and effective drug doses and concentrations for the treatment of two patients who developed an allergic reaction after a nasal filling by intralesional drug injection. Methods Two patients developed severe swelling and deformity of the nose after the injection of fillers 6 months to 1 year prior to presentation. High‐frequency ultrasound and local conditions revealed inflammation in the injected area. The patients were administered the combination of 0.7% triamcinolone acetonide, 0.42% 5‐fluorouracil, and 0.7% lidocaine into the affected area; they were followed up for 6 months. Results After three times of treatment, swelling and sclerosis disappeared after 44.5 ± 2.12 days. No adverse effects of the infections were observed. Conclusions This drug regimen may represent a safe and effective therapeutic strategy for the treatment of complications after soft tissue filler injections.

ABSTRACT Background Cosmetic botulinum toxin type A (BTX‐A) injections have been widely used for improving facial aesthetics. Although the procedure is generally safe, immune‐mediated adverse events, such as hypersensitivity reactions and secondary treatment failures, may rarely occur. We report the first case in which repeated BTX‐A injections resulted in both a delayed‐onset cutaneous hypersensitivity reaction and complete secondary treatment failure. Case Report/Methods A 42‐year‐old female, with a history of successful BTX‐A treatments for glabellar lines and masseter hypertrophy, experienced diminished efficacy following a treatment session. Ten hours after a touch‐up injection, she developed facial swelling and edematous erythema localized to the injection sites. These manifestations persisted for over one month without any observable aesthetic improvement, indicating complete secondary treatment failure. The therapeutic effect was not restored even after switching to an alternative BTX‐A formulation. We hypothesize that the patient's local hypersensitivity reaction represents a type III immune complex‐mediated response (Arthus reaction) driven by IgG antibodies. The repeated BTX‐A injections may have induced neutralizing IgG antibodies that, in concert with the cutaneous hypersensitivity reaction, contributed synergistically to both the cutaneous reaction and the complete treatment failure. The short interval between the injections may have facilitated these immunologic events. Conclusion This case underscores the importance for clinicians to remain vigilant regarding the potential for delayed‐onset cutaneous allergic reactions and complete secondary treatment failure following repeated BTX‐A injections.

Background Vitamin D deficiency is common worldwide and of particular concern for populations at higher latitudes, including those in developed areas such as Australia. The role of vitamin D in modulating bone health and the immune system is well recognized. Patients frequently have vitamin D deficiency identified and managed in the primary healthcare setting. Despite the high prevalence of use in Australia, allergies to supplemental vitamin D are uncommon. Case presentation The case presented here is a 53-year-old Caucasian female of Northern European ancestry, with a history of asthma and irritable bowel syndrome who was prescribed supplemental vitamin D. She experienced dyspepsia and stomach cramps within minutes of ingesting a vitamin D supplement. An alternative formulation of vitamin D produced similar gastrointestinal effects, worsening asthma and a rash. The results of the investigations were unremarkable except for mildly elevated total immunoglobulin levels. The patient was referred to an allergy clinic where a diagnosis of vitamin D hypersensitivity, with features of both immunoglobulin-E-mediated (type 1) and T-cell (type 4)-mediated pathways, was made. A desensitization program was commenced using a modified Australian protocol. During the 18-week course, the patient was exposed to increasing doses of vitamin D, and after 6 months, a daily dose of 1000 IU was tolerated. She continues to use daily antihistamines and avoids foods rich in vitamin D. Conclusion This case report highlights a rare likely allergic reaction to supplemental vitamin D. The patient was never known to have supratherapeutic levels of vitamin D, but her history of atopy may increase the likelihood of an immune-mediated response to the supplement. While skin sensitivity testing was negative, a provocation test and the Naranjo scoring system indicated that a “probable” allergy occurred. Vitamin D deficiency is easily detected in primary healthcare, and oral supplementation is usually a safe and effective means to restore blood levels. While reactions to vitamin D supplementation in normal doses are rare, an allergic cause should be considered when there are no other likely precipitants. Personalized, carefully supervised, desensitization to vitamin D may enable the resumption of supplementation and help prevent unnecessary morbidity and mortality from vitamin D deficiency.