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Am J Trop Med Hyg —8. Prussick R, Shear NH. Dapsone Hypersensitivity Syndrome. J Am Acad Dermatol —9. Lepr Rev — Trop Doct —3. Int J Dermatol — Allergol Int —8. Semin Cutan Med Surg — Int Arch Allergy Immunol — Marotti M.
Rev Assoc Med Bras —8. Br J Dermatol — Aihara M. Pharmacogenetics of Cutaneous Adverse Drug Reactions. J Dermatol — Bras Dermatol — Br J Dermatol —8.
Expert Opin Drug Metab Toxicol — JAMA —9. Nature Asian Pac J Allergy Immunol —3. PubMed Abstract Google Scholar. Indian J Dermatol Venereol Leprol — Pain Pract —8. Hum Mol Genet — N Engl J Med — JAMA — Pharmacogenet Genomics — J Invest Dermatol — N Engl J Med —8. J Pharmacol Exp Ther — Clinical Applications and Methemoglobinemia Induced by Dapsone. J Braz Chem Soc —9. Arch Dermatol —6. Sci Rep —6. Sci Rep — Cancers Basel — Annu Rev Pharmacol Toxicol — Pharmacogenomics — PloS Negl Trop Dis — Expert Opin Drug Saf — JAMA Dermatol — Clin Transl Allergy — Yonsei Med J — Front Pharmacol — Clin Pharmacol Ther —9.
Hum Immunol — J Clin Pharm Ther — Pharmacotherapy — J Postgrad Med —9. Severe Adverse Cutaneous Reactions to Drugs. Negrini S, Becquemont L. Pharmacogenetics of Hypersensitivity Drug Reactions.
Therapie — Tangamornsuksan W, Lohitnavy M. JAMA Dermatol —6. J Dermatol Sci —9. Wozel G, Blasum C. Dapsone in Dermatology and Beyond. Arch Dermatol Res — No others adverse effects were observed during treatment with dapsone.
The term angioedema describes the localizated, transient episodic edema of the deeper layers of the skin or of the mucosa of the gastrointestinal tract. Angioedema affecting the throat, may lead to obstruction of the airways and death from asphyxiation.
The most commonly identified causes of angioedema are medications, allergens and physical agents, but most cases of angioedema are idiopatic 1. Rare forms of angioedema associated with either hereditary or acquired faulty activation of the complement and kallicrein-kinin systems have been extensively described 2,3.
After excluding the most probable causes of angioedema, we conclude that our patient presented an idiopatic angioedema.
In spite of treatment with antihistamines and a daily scheme of oral corticosteroids for 3 months, the patient continued with recurrent episodes so therapy with dapsone was administered. Dapsone, a sulfone is an antibacterial drug for susceptible cases of leprosy. It is also a primary treatment for dermatitis herpetiformis and has been used with slightly greater success in urticarial vasculitis 4 , bullous eruptions 5 , and it has been proposed in cases of severe chronic urticaria to taper off prednisone or in cases of unacceptable side effects of steroids 6.
The mechanism of action of dapsone is poorly understood, its anti-inflamatory effects include reduction in lymphocyte responses to mitogens, suppression of neutrophil chemotaxis, and inhibition of the alternate pathway of complement activation The drug also appears to inhibit spontaneous and induced synthesis of prostaglandin E2 by polymorphonuclear leukocytes 7.
Since dapsone induces severe hemolysis in patients with glucose —6-phosphate dehydrogenase deficiency, this serum enzyme should be measured prior to initiation of such therapy. Others less frequent side effects include headaches, a mild non-he-molytic anemia and most importantly, agranulocytosis.
Thereafter a complete blood counts should be monitored periodically in patients treated with dapsone 8. As in chronic urticaria perhaps some patient with recurrent episodes of idiopathic angioedema may have a good response to dapsone, but the response may be unpredictable in each patient, and side effects must be monitored.
We conclude, that dapsone may be an alternative drug in extrem cases of chronic urticaria or idiopathic angioedema that precise corticosteroids for extended periods as a steroid-sparing drug or in cases with poor response to conventional therapy. Inicio Allergologia et Immunopathologia Idiopatic angioedema treated with dapsone. ISSN: See more Follow us:. Previous article Next article. Issue 1. Pages January Export reference. More article options.
DOI: Download PDF. Soriano a , T. Caballero b , E. Niveiro a. This item has received. Article information. The most commonly identified causes of angioedema are medications, allergens and physical agents, but most cases of angioedema are idiopathic.
Case report: A year-old man presented with a 3-month history of recurrent severe episodes of angioedema affecting the lips, tongue and throat. A fiberoptic examination revealed laryngeal edema during some episodes. He did not report abdominal pain, nausea or vomiting. No precipitating factors were identified. The patient was not receiving angiotensin-converting enzyme inhibitors.
For the previous 4 years, the patient had been receiving levothyroxine for autoimmune thyroiditis. There was no history of facial palsy or hereditary angioedema.
Allergy study: Skin prick test with aeroallergens, food, latex, Anisakis and patch test to a standard series true test were negative. Laboratory investigations revealed normal complete blood count CBC , erythrocyte sedimentation rate, urinalysis, blood biochemistry, serum protein electrophoresis and serum immunoglobulins. Antinuclear antibodies serum immune complexes and rheumatoid factor were negative. Complement study during acute and asymptomatic periods revealed normal values of C1 esterase inhibitor, C1q, C3, C4, functional activity of C1 inhibitor and CH No pathologic findings were observed in a lip biopsy.
Glucose 6 phosphate dehydrogenase deficiency had previously been ruled out. The patient improved and antihistamine and corticoid treatment was withdrawn 1 month after starting the dapsone regimen. No episodes of angioedema appeared during the subsequent year. No reductions in hematologic parameters or adverse events were detected. Dapsone may be an alternative drug in extreme cases of idiopathic angioedema in patients with poor response to conventional therapy..
Idiopathic angioedema. Palabras clave:. Full Text. Correspondence: P. Clin Rev Allergy Immuno, 23 , pp. Immunobiolog, , pp. Medicine Baltimore, 71 , pp.
❿- Idiopatic angioedema treated with dapsone | Allergologia et Immunopathologia
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DrivingQ:Can I validity if I have used Benzac AC 2. A:Benzac AC has no or allergic influence on the role to drive.
However, studies have not highlighted the importance of other genetic polymorphisms in dapsone-induced severe cutaneous adverse reactions SCAR. However, the most frequent adverse drug reactions of dapsone are dose-dependent adverse effects hemolytic anemia and methemoglobinemia and rarely dose-independent adverse effects dapsone hypersensitivity syndrome 2. Dapsone hypersensitivity syndrome DHS or dapsone-induced hypersensitivity reactions DIHRs is a life-threatening drug reaction and usually manifested between the 4 and 6 weeks after initiation of treatment.
The clinically characterized through fever, rash, hepatitis or systemic involvement, lymphadenopathy, and abnormal hematologic system eosinophilia or atypical lymphocytosis 3. There was found approximately 0. Severe cutaneous adverse drug reactions SCARs is a type of adverse drug reactions ADRs that remains a rare but potentially severe life-threatening adverse effect and major problems for both clinical treatment and pharmaceutical industry 8.
Drug reaction with eosinophilia and systemic symptoms DRESS are characterized by a skin rash usually occurring more than 2 weeks after drug initiation with fever, hepatitis or internal organ involvement, lymphadenopathy, and hematological abnormalities eosinophilia or atypical lymphocytosis Although the exact mechanism of SCARs remains unclear, numerous studies have described the associations between human leukocyte antigen HLA and cytochrome P genes with the specific drug hypersensitivity reaction 15 Furthermore, Dapsone is metabolized through acetylation and N-hydroxylation.
In human study, they found a relation between the rate of N-hydroxylation and clearance of dapsone by cytochrome P Moreover, SJS-TEN with severe ocular surface complications SOC was diagnosis with history of acute-onset high fever, serious mucocutaneous illness with skin eruption, and the involvement of at least two mucosal sites oral cavity and ocular surface All patients with dapsone-induced SCARs were accessed through review of photographs, pathologic slides, and medical records by two dermatologists.
Forty dapsone-tolerant controls who had been non-leprosy Thai patients and received dapsone more than 6 months without any cutaneous adverse reaction. In addition, unrelated healthy Thai population were recruited for this study.
Written informed consent was obtained from each patients before enrollment. PDB as the template structure. The protonation states of all ionizable amino acids were assigned at pH 7.
Statistical analysis was performed using SPSS version P -values were less than 0. The demographic and clinical data of patients with dapsone-induced SCARs and controls are listed in Table 1. The 16 patients with dapsone-induced SCARs consisted of 10 females Dapsone was used among the cases and controls for the HIV prophylaxis Eight patients The hematological abnormalities and hepatitis were more prominent among the dapsone cases, as shown in Table 1.
Furthermore, the most common of co-medication used among the dapsone cases and controls were colchicine, efavirenz, lamivudine, and acyclovir. We found that These results were confirmed by corrected p -value of HLA-B alleles 2. The docking results in Table 8 showed that although dapsone likely interacted with both proteins via an insertion of its —NH 2 group into the F-pocket Previous study, we found the incidence of DHS among non-leprosy patients 1.
The biogeographical ancestry has important role in express a range of pharmacogenetics alleles and several type of SCARs. Further studies should investigate the association of pharmacogenetics marker and dapsone-induced SCARs in other population, especially Europeans and Africans.
The sulfonamide structure is the basis of many drugs. Base on the sulfonamides structure can be divided into three types, consisting of sulfonylarylamines, non-sulfonylarylamines, and sulfonamide moiety-containing drugs Consequently, the cross-reactivity of sulfonamide hypersensitivity reactions have been reported among sulfonylarylamines antimicrobial sulfonamides Particularly, structure of dapsone is comprised of the simplest of the sulfones, there is considerable cross-reactivity among various sulfonamide structure.
Dapsone is metabolized in the liver by nitrogen N -acetylation and N- hydroxylation. CYP2C9 extensively metabolizes co-trimoxazole and influences reactive metabolites induced cytotoxicity 53 There is an association of mucosal involvement, hepatitis, higher age, and disease occurrence with a higher risk of fatal outcome of dapsone hypersensitivity syndrome Nevertheless, the number of subjects in this study may not be sufficient enough to confirm all the assumptions.
Further studies using a large number of samples are required for better comprehension. Specific HLA allele plays a major immunopathogenesis role of drug hypersensitivity reactions, several hypotheses have been proposed to explain the interaction of HLA, drugs, peptides, and T cell While, the direct pharmacological interaction p-i model involves a non-covalent and labile interaction of the drug with HLA at the cell surface independent of antigen processing or T cell receptor.
Another hypothesis, the altered peptide repertoire model, suggests the drug or its metabolites can bind non-covalent within the pocket of binding groove of certain HLA allele 34 The datasets presented in this study can be found in online repositories. All authors helped to perform the research. CS contributed to drafting conception, design, and contribution to writing the manuscript.
All authors contributed to the article and approved the submitted version. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors thank the study participants and staffs of Pharmacogenomic and Personalized Medicine of Ramathibodi Hospital. Dapsone and Sulfones in Dermatology: Overview and Update. J Am Acad Dermatol — Am J Trop Med Hyg —8. Prussick R, Shear NH.
Dapsone Hypersensitivity Syndrome. J Am Acad Dermatol —9. Lepr Rev — Trop Doct —3. Int J Dermatol — Allergol Int —8. Semin Cutan Med Surg — Int Arch Allergy Immunol — Marotti M. Rev Assoc Med Bras —8.
Br J Dermatol — Aihara M. Pharmacogenetics of Cutaneous Adverse Drug Reactions. J Dermatol — Bras Dermatol — Br J Dermatol —8. Expert Opin Drug Metab Toxicol — JAMA —9. Nature Asian Pac J Allergy Immunol —3. PubMed Abstract Google Scholar. Indian J Dermatol Venereol Leprol — Pain Pract —8. Hum Mol Genet — N Engl J Med — JAMA — Pharmacogenet Genomics — J Invest Dermatol — N Engl J Med —8.
J Pharmacol Exp Ther — Clinical Applications and Methemoglobinemia Induced by Dapsone. J Braz Chem Soc —9. Arch Dermatol —6. Sci Rep —6. Sci Rep — Cancers Basel — Annu Rev Pharmacol Toxicol — Pharmacogenomics — PloS Negl Trop Dis — Expert Opin Drug Saf — JAMA Dermatol — Clin Transl Allergy — Yonsei Med J — Front Pharmacol — Clin Pharmacol Ther —9.
Hum Immunol —
A severe motor and a minor sensory neuropathy developed in a man being treated with dapsone (4,4′-diaminodiphenylsulfone) for dermatitis herpetiformis. Dapsone is a sulfone commonly used in the treatment of dermatological diseases, eg, leprosy and dermatitis herpetiformis and, on occasion, in the treatment. Dapsone-induced Methemoglobinemia in a Patient of Leprosy He was on dapsone-based ( mg OD) multi-drug therapy for Hansen's disease Vet Res Forum. HLA-B* allele has been identified as the genetic determinant of dapsone hypersensitivity syndrome (DHS) among leprosy and non-leprosy. Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease. J Braz Chem Soc —9. Severe Adverse Cutaneous Reactions to Drugs. Occasionally, the opinion of an expert on a burning topic is published in the "Point of View" section. J Dermatol —Allergologia et Immunopathologia is no longer published on Elsevier since the year. Transferred to Codon Publications Allergologia et Immunopathologia is a forum for those working in the field of asthma, allergy and immunology related to childhood. Manuscripts related to clinical, epidemiological and experimental allergology and childhood immunopathology will be considered for publication.
It has and independent international Editorial Committee which submits received papers for peer-reviewing by international experts. The journal accepts original and review articles from all over the world, together with consensus statements from the aforementioned societies. Occasionally, the opinion of an expert on a burning topic is published in the "Point of View" section. Letters to the Editor on previously published papers are welcomed. Allergologia et Immunopathologia publishes 6 issues per year and is included in the major databases such as Pubmed, Scopus, Web of Knowledge, etc.
The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.
SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Angioedema is a constellation of syndromes that present a challenge to the clinician. The most commonly identified causes of angioedema are medications, allergens, and physical agents, but most cases of angioedema are idiopathic.
A 48 year old man, presented to our Allergy Unit in May 02, because recurrent severe episodes of angioedema affecting the lips, tongue, and throat. He often presented at the Emergency room once or twice a week for the last 3 months with tongue and lips swelling, dysphonia and dyspnea.
A fiber optic examination revealed mild laryngeal edema during some episodes, that resolved within a few hours after treatment with epinephrine, antihistamines or corticosteroids.
The patient did not related episodes of abdominal pain, nauseas or vomiting. No precipitating factor was identified. He had not been taken angiotensin-converting enzyme inhibitors. The last 4 years he was receiving levothyroxine, be-cause an autoimmune thyroiditis. There was no history of facial paralysis or hereditary angioedema. Physical examination revealed edema limited to the lower lip, the remainder of his examination was unremarkable. Laboratory investigation revealed normal complete blood count CBC , erythrocyte sedimentation rate, urinalysis, blood biochemistry liver and renal function tests , C reactive protein, serum protein electrophoresis, serum immunoglobulins.
Serum immune complexes, antinuclear antibodies and rheumatoid factor were negative. Complement study during acute and asymptomatic periods revealed normal values of C1 esterase inhibitor, C1q, C3, C4 and CH Three different stool samples were negative for parasites. X-ray studies of thorax and paranasal sinuses showed normal findings.
A biopse of the lip was performed to exclude a cheilitis granulomatosa. No pathologic findings were observed in such specimen. The patient was treated with sedating and nonsedating H1 antihistamines and corticosteroids prednisone: 30 mg every day during 3 months with no clinical improvement. So we decided to start treatment with dapsone 50 mgs daily previously a deficiency of glucose 6 phosphate dehydrogenase was excluded.
Clinically the patient improved and during the subsequent year, no episodes of angioedema appeared. Corticosteroids and antihistamines were stopped one month after starting treatment with dapsone.
CBCs were performed weekly during the first month of therapy, monthly for the next 6 months and every 6 months thereafter. No reduction in leukocytes, platelets, or hematopoiesis was detected. No others adverse effects were observed during treatment with dapsone. The term angioedema describes the localizated, transient episodic edema of the deeper layers of the skin or of the mucosa of the gastrointestinal tract.
Angioedema affecting the throat, may lead to obstruction of the airways and death from asphyxiation. The most commonly identified causes of angioedema are medications, allergens and physical agents, but most cases of angioedema are idiopatic 1. Rare forms of angioedema associated with either hereditary or acquired faulty activation of the complement and kallicrein-kinin systems have been extensively described 2,3.
After excluding the most probable causes of angioedema, we conclude that our patient presented an idiopatic angioedema. In spite of treatment with antihistamines and a daily scheme of oral corticosteroids for 3 months, the patient continued with recurrent episodes so therapy with dapsone was administered. Dapsone, a sulfone is an antibacterial drug for susceptible cases of leprosy. It is also a primary treatment for dermatitis herpetiformis and has been used with slightly greater success in urticarial vasculitis 4 , bullous eruptions 5 , and it has been proposed in cases of severe chronic urticaria to taper off prednisone or in cases of unacceptable side effects of steroids 6.
The mechanism of action of dapsone is poorly understood, its anti-inflamatory effects include reduction in lymphocyte responses to mitogens, suppression of neutrophil chemotaxis, and inhibition of the alternate pathway of complement activation The drug also appears to inhibit spontaneous and induced synthesis of prostaglandin E2 by polymorphonuclear leukocytes 7.
Since dapsone induces severe hemolysis in patients with glucose —6-phosphate dehydrogenase deficiency, this serum enzyme should be measured prior to initiation of such therapy.
Others less frequent side effects include headaches, a mild non-he-molytic anemia and most importantly, agranulocytosis. Thereafter a complete blood counts should be monitored periodically in patients treated with dapsone 8. As in chronic urticaria perhaps some patient with recurrent episodes of idiopathic angioedema may have a good response to dapsone, but the response may be unpredictable in each patient, and side effects must be monitored.
We conclude, that dapsone may be an alternative drug in extrem cases of chronic urticaria or idiopathic angioedema that precise corticosteroids for extended periods as a steroid-sparing drug or in cases with poor response to conventional therapy. Inicio Allergologia et Immunopathologia Idiopatic angioedema treated with dapsone.
ISSN: See more Follow us:. Previous article Next article. Issue 1. Pages January Export reference. More article options. DOI: Download PDF. Soriano a , T. Caballero b , E. Niveiro a. This item has received. Article information.
The most commonly identified causes of angioedema are medications, allergens and physical agents, but most cases of angioedema are idiopathic. Case report: A year-old man presented with a 3-month history of recurrent severe episodes of angioedema affecting the lips, tongue and throat. A fiberoptic examination revealed laryngeal edema during some episodes. He did not report abdominal pain, nausea or vomiting.
No precipitating factors were identified. The patient was not receiving angiotensin-converting enzyme inhibitors. For the previous 4 years, the patient had been receiving levothyroxine for autoimmune thyroiditis. There was no history of facial palsy or hereditary angioedema. Allergy study: Skin prick test with aeroallergens, food, latex, Anisakis and patch test to a standard series true test were negative.
Laboratory investigations revealed normal complete blood count CBC , erythrocyte sedimentation rate, urinalysis, blood biochemistry, serum protein electrophoresis and serum immunoglobulins. Antinuclear antibodies serum immune complexes and rheumatoid factor were negative. Complement study during acute and asymptomatic periods revealed normal values of C1 esterase inhibitor, C1q, C3, C4, functional activity of C1 inhibitor and CH No pathologic findings were observed in a lip biopsy.
Glucose 6 phosphate dehydrogenase deficiency had previously been ruled out. The patient improved and antihistamine and corticoid treatment was withdrawn 1 month after starting the dapsone regimen.
No episodes of angioedema appeared during the subsequent year. No reductions in hematologic parameters or adverse events were detected. Dapsone may be an alternative drug in extreme cases of idiopathic angioedema in patients with poor response to conventional therapy.. Idiopathic angioedema. Palabras clave:. Full Text. Correspondence: P. Clin Rev Allergy Immuno, 23 , pp. Immunobiolog, , pp. Medicine Baltimore, 71 , pp. Hypocomplementemic urticarial vasculitis syndrome responsive to dapsone.
J Am Acad Dermato, 15 , pp. Dapsone:Unapproved uses or indications. Clin Dermato, 18 , pp. Treatment of patients with chronic idiopathic urticaria. AHFS drug information. American Society of Health-System Pharmacists. American Society of Health-System Pharmacists, , pp.
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