LUCILA DE CAMPOS
Projetos de Pesquisa
Unidades Organizacionais
LIM/60 - Laboratório de Imunologia Clínica e Alergia, Hospital das Clínicas, Faculdade de Medicina
3 resultados
Resultados de Busca
Agora exibindo 1 - 3 de 3
- Update on Desensitization(2019) CAMPOS, Lucila; HAMADI, Sahar A.; LYNCH, Donna-Marie; MARQUIS, Kathleen; CASTELLS, Mariana C.Purpose of reviewRapid drug desensitization (RDD) is a high-risk protocol that allows patients with hypersensitivity reactions to remain on first-line therapy for their underlying conditions through titration of dose increments and infusion rates. The aim of this paper is to review the most recent desensitization protocols available for drugs that are commonly used in clinical practice settings and to provide algorithms for their appropriate usage.Recent findingsRDD protocols involve identification of phenotypes and endotypes during the initial reaction, risk stratification, skin testing, and specific biomarkers. Patients' protocols are personalized and can increase life expectancy and quality of life.SummaryThe benefits of RDD largely outweigh the risks. All patients with hypersensitivity reactions should be evaluated for desensitization, to avoid alternatives treatments that may be less effective or intolerant patients presenting with SCARS (DRESS/SJS/TEN) are not candidates for desensitization since the mechanism of the reactions are poorly understood.
- Basophil Activation Test as a Biomarker for Taxanes Anaphylaxis(2022) CAMPOS, Lucila De; GIAVINA-BIANCHI, Pedro; ACHARYA, Shree; LYNCH, Donna-Marie; KALIL, Jorge; CASTELLS, Mariana C.IntroductionTaxanes are widely used chemotherapy agents, and their administration, despite premedication, is associated with hypersensitivity reactions (HR) in up to 9% of patients, 1% of which are severe. The mechanisms of these reactions are not fully understood. Finding biomarkers for early diagnosis and better understanding the underlying mechanisms of these reactions are key to defining the best treatment strategy for patients.MethodsThe purpose of this study was to evaluate the effectiveness of the basophil activation test (BAT) to diagnose patients with anaphylactic reactions to taxanes. Patients with anaphylaxis to taxane compounds (n = 15) were assessed through clinical history, skin testing (when possible), and BAT. BAT was performed immediately before rapid drug desensitization or before skin testing using anti-CD123 conjugated (APC-Biolegend), anti-HLADR conjugated (FITC-Biolegend) to gate Basophils and anti-CD63 conjugated (PE-Biolegend), and anti-CD203c conjugated (BV-Biolegend) to assess CD203c and CD63 expression on basophils under taxane stimulation. BAT was also performed in eight healthy volunteers.ResultsBAT was positive for CD203c in eight out of 15 patients and for CD63 in four out of 15 patients and in two out of eight controls. The sensitivity for CD203c was 53%, the specificity was 87%, and the area under the curve was 0.66 (p = 0.19%). For CD63, these rates were 33%, 87%, and 0.6 (p = 0.4). In a subgroup analysis of patients with positive skin tests (11 patients), CD203c was positive in six patients (sensitivity of 54.5% and specificity of 87.5%), and CD63 was positive in five patients (sensitivity of 45% and specificity of 75%).ConclusionsBAT as a diagnostic tool for immediate hypersensitivity reactions to taxanes may be relevant in patients with selected phenotypes and endotypes, especially those with severe reactions or when the diagnosis cannot be established by the skin test. Increased expression of CD203c was more frequent than of CD63 in patients with positive results, and the sensitivity of this biomarker was higher in patient sub-group with positive skin tests, i.e., patients with IgE-mediated endotypes.
- BAT in the Diagnosis of Drug Allergy: a Novel Tool in Clinical Daily Practice?(2019) CAMPOS, Lucila; GALVAO, Violeta Regnier; KALIL, Jorge; CASTELLS, Mariana; GIAVINA-BIANCHI, PedroPurpose of ReviewThe aim of this study is to critically review the relevant literature published on basophil activation test, presenting the current knowledge and future perspectives.Recent FindingsBasophil activation test (BAT) results varied accordingly to the class of the drug studied, and have promising results in immediate hypersensitivity reactions to pyrazolone (selective reactors), neuromuscular blockers, beta-lactams, and platinum compounds, all examples of classical IgE-mediated hypersensitivity drug reactions.SummaryCurrently, BAT is applied in research settings, but based in the results of our review, the test can be considered as a diagnostic tool for daily practice for selected patients and selected drugs, when the test is available, particularly for patients who experienced severe reactions and when diagnosis cannot be stablished by serum-specific IgE and skin testing, in order to avoid unnecessary drug provocations tests.