48 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0009 Allergy
Successful Combined Intranasal Ketorolac and Low Dose Oral Aspirin Desensitization
Inseon S. CHOI1, Ga-Ram KIM1, Jin-Woo WI1 Chonnam National University Hospital, Korea1
In 2010, Lee et al. (Ann Allergy Asthma Immunol 2010;105:130) reported that intrana- sal ketorolac desensitization followed by rapid oral aspirin desensitization protocol was effective, safe, and less time-consuming than the standard oral one. Although they could perform successfully the protocol in out-patient clinics, their patients were given standard oral aspirin for maintenance. By the way, a 61 years-old woman with aspirin intolerance had been hospitalized 5 times due to her forgetfulness that she should take aspirin every day for maintaining the aspirin desensitization. Therefore, after the induction according to a modifi ed (last oral dose: 500 mg) protocol by Lee et al., she was given intranasal ketorolac for maintenance of desensitization. Because the effect of aspirin desensitization depends on the maintenance dose of aspirin, and because it is possible that the dose of intranasal ketorolac would not be enough to be effective, she was given additional oral aspirin 100 mg qd. Two weeks later, she was challenged with oral aspirin 250 mg followed by 500 mg 1.5 hr later without any symptoms.
Other 5 patients also successfully induced, 4 of them did not respond to the challenge with oral aspirin 500 mg 2 weeks later, and one patient are now waiting the oral chal- lenge. One patient with severe aspirin intolerance failed to induce the desensitization.
The other 4 patients, who had received standard oral aspirin for a long time, changed their oral aspirin to combined intranasal ketorolac and low dose (100 mg) oral aspi- rin and 3 of them did not respond to oral aspirin 500 mg 2 weeks later. One patient discontinued low dose oral aspirin for his operation of intestinal hernia. Collectively, combined intranasal ketorolac and low dose oral aspirin seems to be effective and safe for maintaining aspirin desensitization.
PS 0010 Allergy
Polyhedral Allergy
Gulcin GUNGOR OLCUM1, Fidan Canan CELIK YAGAN2, Guven KOC1, Ece YIGIT TASKIN1, Hanife Serife AKTAS1, Sati Sena YILDIZ1, Fatih AKDOGAN1, Senem ERTILAV1, Sibel SERIN1, Sema BASAT1
Umraniye Training and Research Hospital, Turkey1, Zeynep Kamil Training and Research Hospital, Tur- key2
Drug allergies can be manifested in a wide specturum such as a mild skin rash to life-threatening epidermal necrolysis. Therefore,allergic reactions, needs to be always kept in mind and etiology should be investigated througly.
Case: 43 year old female patient was admitted to our department due to high fever, palpitations and sweating. In physical examination the patient was agitated, her skin was humid and fever was above 39.50C. Her pulse: 125/min, arterial pressure: 80/50 mmHg, respiration: 26/min.In the right gluteal region there was fronculosis. Because of her breast cancer, she had taken chemotherapy recently. For the treatment of froncu- losis, she was taking moxifl oxacin. Patient was then evaluated by Infectious diseases and due to the current fi ndings intravenous targocid and tazobactam was started. The patient’s vital signs returned to normal and agitation dissappeared after admission to hospital within 8 hours. Maculopapular skin rashes, occurred after 12 hours after the beginning of IV antibiotic treatment therefore they were discontinued and oral ciprofloksasin and amoksisilin with kluvanat was started. Patient showed; per-oral hypoesthesia,agitation,palpitations just after 3 hours of ciprofl oxacin treatment. In the physical examination;the patient was agitated, pulse: 110/min and sinus tachycardia was present, other systems were normal.The patient’s condition was similar as her admission to the hospital. The emergence of the similar complaints suggested hyper- sensitivity reaction. Antibiotics were stopped and oral Antihistaminic treatment was started. Vital signs returned to normal after antihistaminic treatment.Agitation and peroral hipoesthesia were resolved
Discussion and Conclusion: In the literature; the fluoroquinolones caused adverse events, such as hypotension, tachycardia, long QT syndrome, Torsades de pointese and even cardiac death. In our case, the high fever, tachycardia,hypotension, and neuro-
logic fi ndings were present. There was no skin fi ndings when the patient was admitted to the hospital. Complaints after Ciprofl oxacin treatment were similar to the patients complaints at the hospital admission. Thus, our clinical diagnosis confi rmed hyper- sensitivity reaction due to moxifl oxacin treatment. In particular,as in our case,become drug hyper-sensitivity reactions and infectious diseases findings, can very similar.
Therefore drug allergies should always be kept in mind.
PS 0011 Immunology
FTY720 Binds to Affi nity For G Protein-Coupled Sphin- gosine-1-Phosphate on Lymphocytes, Inhibiting CD+4 CD+8 T-Cells and B-Cells Thought to Prevent CNS for Reduction of Relapsing-Remitting Multiple Sclerosis
Soonei HWANGBO1, Sunyi HWANGBO1 Pusan National University YangSan Hospital, Korea1
Background: Multiple Sclerosis (MS) is a progressive neurologic illness is thought to trigger an autoimmune response that leads ultimately to demyelination in the central nervous system (CNS). restricting lymphocytes to be a FTY720-dependent decrease the internalization of S1P1 renders these cells unresponsive to S1P depriving lym- phocytes of the obligatory signal to egress of lymphocytes from lymphoid tissue and thus reduction of auto-aggressive T-lymphocytes in the peripheral recirculation and the central nervous system actions that are mediated by the S1P1 receptor subtype down-modulation causes a reversible retention of a proportion of CD4 and CD8 posi- tive T-cells and B-cells from blood and spleen into lymph nodes could be of benefi t.
Methods: The objective was to compare two doses of FTY720 (1.25 mg and 0.5 mg) with annualized relapse rate (ARR), the Expanded Disability Status Scale(EDSS) in pa- tients treated for up to 24 months.
Results: Immune function Blood and spleen samples were taken in Weeks 42-43 for in vitro analysis of the immune function. the proliferative responses of B- and T-cells were suppressed at both doses by 52.1-96% and 88.9-97.2% compared to control animals. In trial D2301, treatment of both doses of FTY720 1.25 mg and 0.5 mg resulted in a signifi cantly lower aggregate ARR compared to placebo, with ARR esti- mates of 0.16 and 0.18 vs. 0.40 respectively. treatment with both doses of FTY720 1.25 mg (p=0.012) and 0.5 mg(p=0.024) resulted in a signifi cantly reduced risk of disability progression compared to treatment with placebo in patients with RRMS.
Conclusions: This review provides an overview of our understanding of CD8+ T cells in immune-mediated disease, focusing particularly on our fi ndings regarding regulato- ry CD8+T cells both in MS and in EAE.
