Presentation and objectivesAllergic Drug Reactions constitute a global problem that supposes a decrease in the quality of life of the patient and an important expense for the health system. These reactions are classified as immediate and non-immediate, depending on the time interval between taking the drug and the appearance of symptoms. Immediate reactions generally occur within the first hour after consumption of the drug, are mediated by specific IgE antibodies, and the most frequent symptoms are urticaria and anaphylaxis. Late reactions usually occur 24-48 hours after taking the drug (although they can also develop in a shorter period of time such as 1 or 2 hours after ingestion), they are mediated by T cells and the most frequent symptom is rash. . The most frequent reactions are produced by antibiotics, mainly from the group of beta-lactams (BL) and fluoroquinolones, followed by nonsteroidal anti-inflammatory drugs (NSAIDs). Almost half of hospitalized patients need antibiotics, and of these, 10-15% are considered allergic to BL and receive alternative treatment that is not first-line. This implies an increase in therapeutic failure, secondary effects, and infections by bacteria such as Clostridium difficile, with allergy to BL being a factor associated with the increased prevalence of antibiotic-resistant infections. This is relevant, as 70-90% of hospitalized and outpatients considered allergic to BL may not be. Translated into costs, the hospital admission and outpatient treatment of a patient “labeled” as allergic to BL is more expensive (€ 520 and € 165 respectively) than that “not labeled”. Considering additional costs, such as days of hospital stay, the savings from eliminating the allergy "label" represents up to € 3,630 per patient.
The proactive approach to the diagnosis of BL allergy has a great impact on the health system, and should be a strategy of the antimicrobial use optimization programs. Thus, in the USA and Australia different actions have been proposed in hospitalized patients: (i) perform skin tests (PC) and controlled exposure tests (PEC) with the involved BL, which, although it is the best clinical practice, requires a permanently available allergist; ii) stratify patients in risk levels and administer cephalosporins or carbapenems, a practical approach that does not confirm whether the patient is allergic or not. In Europe, the strategy is aimed at diagnosing the patient who reports having presented a reaction, prior to hospital admission, using standardized protocols. This strategy is being applied to other groups of antibiotics. Taking into account that at present, the development of new antibiotics is not among the priorities of the pharmaceutical industry and there is a continuous increase in the rates of bacterial resistance, the knowledge on the part of all medical practitioners of the management of this type is essential. of reactions.
NSAIDs are the second leading cause of allergic reactions to drugs in the general population and these can be produced by immunological or non-immunological mechanisms. Reactions mediated by a specific immunological mechanism (IgE or T cells) or selective hypersensitivity reactions (HS) are induced by NSAIDs belonging to a single pharmacological group, the patient tolerating NSAIDs from other groups with different chemical structures. Reactions mediated by a non-immunological mechanism or cross-intolerance (IC) reactions are produced by alteration of arachidonic acid metabolism and are related to the inhibition of the enzyme cyclooxygenase (COX) -1 and the decrease in prostaglandin synthesis (PG ) -E2, with cross-reactivity to different chemically unrelated NSAIDs. IC reactions are more frequent than those of HS reactions, representing 74-58% and 41-25%, respectively. This complicates the diagnosis since PECs are the only available tool. Finally, we must not forget that there are other groups of drugs, radiological contrast media and chemotherapeutic agents, which induce allergic reactions with a certain frequency and that because in many cases there is no alternative, a precise diagnosis and complex therapeutic measures such as desensitization are necessary.ProgramModule 1. Generalities and Mechanisms Involved in Allergic Reactions to Drugs: Immunological, Non-Immunological, and Genetic (9 ECTS credits).
Module 2: Clinical Manifestations of Allergic Reactions to Drugs. (5 ECTS credits).
Module 3: General Bases of the Diagnosis of Allergic Reactions to Drugs. (5 ECTS credits).
Module 4: Specific Aspects of Allergic Reactions to Drugs. (12 ECTS credits).
Module 5: Treatment and Management of Allergic Reactions to Drugs. (6 ECTS credits).
Module 6: Research, Innovation, and Special Aspects of Allergic Reactions to Drugs. (11 ECTS credits).
Final Master's Project: 12 ECTS credits