The aim of the present study is to describe pharmacological characteristics of drug-related allergies and anaphylaxis leading to the emergency department (ED). An 8-year post hoc analysis on the MEREAFaPS Study database was performed (2012–2019). Subjects who experienced drug-related hypersensitivity leading to an ED visit were selected. Logistic regression analyses were used to estimate the reporting odds ratios (RORs) of drug-related allergies and anaphylaxis adjusting for sex, age classes, and ethnicity. In addition, a systematic review of observational studies evaluating drug-related hypersensitivity reactions leading to ED visits in outpatients was performed. Out of 94,073 ED visits, 14.4% cases were drug-related allergies and 0.6% were anaphylaxis. Females accounted for 56%. Multivariate logistic regression showed a higher risk of drug-related allergy among males and all age classes < 65 years, while a higher risk of anaphylaxis was observed for females (ROR 1.20 [1.01–1.42]) and adults (ROR 2.63 [2.21–3.14]). The systematic review included 37 studies. ED visits related to allergy and anaphylaxis ranged from 0.004% to 88%, and drug-related allergies and anaphylaxis ranged from 0.007% to 88%. Both in our analysis and in primary studies, antibacterials, analgesics, and radiocontrast agents were identified as the most common triggers of hypersensitivity.

This post hoc analysis of an Italian active pharmacovigilance study describes pharmacological differences of ADEs leading to emergency department (ED) visits and hospitalization in women and men. During the study period (January 2007–December 2018), 61,855 reports of ADEs leading to ED visits were collected. Overall, 30.6% of ADEs resulted in hospitalization (30% in women and 31% in men). Multivariate logistic regression showed that, among women, drug classes significantly associated with an increased risk of hospitalization were heparins (ROR 1.41, CI 1.13–176), antidepressants (ROR 1.12, CI 1.03–1.23) and antidiabetics (ROR 1.13, CI 1.02–1.24). Among men, only vitamin K antagonists (ROR 1.28, CI 1.09–1.50), opioids (ROR 1.30, CI 1.06–1.60) and digitalis glycosides (ROR 1.32, CI 1.09–1.59) were associated with a higher risk of hospitalization. Overall, older age, multiple suspected drugs and the presence of comorbidities were significantly associated with a higher risk of hospitalization. A significantly reduced risk of hospitalization was observed in both women and men experiencing an adverse event following immunization (ROR 0.36, CI 0.27–0.48 and 0.83, 0.42–0.74, respectively) compared to drugs. Results obtained from this real-world analysis highlight important aspects of drug safety between sexes.

COVID-19 Acute Respiratory Distress Syndrome (CARDS) is the most serious complication of COVID-19. The SARS-CoV-2 outbreaks rapidly saturated intensive care unit (ICU), forcing the application of non-invasive respiratory support (NIRS) in respiratory intermediate care unit (RICU). The primary aim of this study is to compare the patients’ clinical characteristics and outcomes (Helmet-Continuous Positive Airway Pressure (H-CPAP) success/failure and survival/death). The secondary aim is to evaluate and detect the main predictors of H-CPAP success and survival/death. A total of 515 patients were enrolled in our observational prospective study based on CARDS developed in RICU during the three Italian pandemic waves. All selected patients were treated with H-CPAP. The worst ratio of arterial partial pressure of oxygen (PaO₂) and fraction of inspired oxygen (FiO₂) PaO₂/FiO₂ during H-CPAP stratified the subjects into mild, moderate and severe CARDS. H-CPAP success has increased during the three waves (62%, 69% and 77%, respectively) and the mortality rate has decreased (28%, 21% and 13%). H-CPAP success/failure and survival/death were related to the PaO₂/FiO₂ (worst score) ratio in H-CPAP and to steroids’ administration. D-dimer at admission, FiO₂ and positive end expiratory pressure (PEEP) were also associated with H-CPAP success. Our study suggests good outcomes with H-CPAP in CARDS in RICU. A widespread use of steroids could play a role.

Introduction: In RCTs, oral anticoagulants, both vitamin K inhibitors (VKAs) and direct anticoagulants (DOACs) have proven to be useful in preventing and treating thromboembolic diseases. A retrospective cohort study was conducted for one year in the Medical ward of the Vimercate Hospital to identify patient characteristics with adverse reactions from anticoagulants. The aim of the study was to evaluate the incidence of anticoagulants serious adverse drug reactions conditioning hospital admission, the percentage of preventable reactions and the feasibility of a larger study, with the inclusion of several Medical Wards. Methods: Among the hospitalized patients between November 1, 2015 and October 31, 2016, patients admitted in Internal Medicine departments were selected. Patients with ADR from anticoagulants were identified. Results: In the period included there were 2064 admissions in the departments of Internal Medicine. 102 eligible patients were identified (4.9%); of these 48 were females, 54 males. The average age was 81.9 (from 60 to 95 years). Out of 102 cases, 68 used AVKs and 34 DOACs. The admission diagnosis was cardiac failure following anemia or hemorrhage (56 cases), acute hemorrhage, sometimes not associated with anemia (29 cases), anemia not associated with evident hemorrhage (17 cases). The risk of bleeding during therapy with VKAs, analyzed with the HAS-BLED score showed that 65 out of 68 patients had a score >3, which correlates with a high risk of major bleeding. Overall, the 96% of ADRs with VKA was preventable, and the 68% of ADRs with DOACs too. The two rates are not comparable, due to the different criteria used. Discussion and Conclusions: This study highlights the large percentage of adverse reactions from oral anticoagulants that can be avoided with more careful patient management. A clinical picture of cardiac failure often leads to a diagnosis of hemorrhage/anemia; Periodic check up of cardiac and renal function and of blood count may be very useful, especially in older patients and in those in therapy with DOACs. A larger study, including patients from different hospitals, could yeld a higher general value.

Background/Objectives: Recent researches on Mortality rate (MR) Vs Bionomic functionality (BF) in the territory of the province of Monza and Milan led to the knowledge of the state of the environment of each municipality. This study verifies the need for an anamnesis capable of highlighting the presence of Cumulative Environmental Stress (ECS) and verifies the differences between smoking and non-smoking patients in their relationship with the living environment. Methods: Two questionnaires collected the patients' responses. Their evaluation is based on the cumulative impact of stress due to an incorrect Cumulative Wrong Relationships (cWR), detected through Physio-Environmental parameters (Wrong Relationships (WR-Phys)) increased by the stress due to the Wrong Relationships "Psychosocial" environment (WR-PSoc). These tables were tested in the Pneumology department of the Vimercate Hospital (Monza-Brianza) in 70 lung cancer patients. cWR receives a further cumulative impact from the bionomic conditions of the landscape unit where the patient lives, measurable by BF, leading to ECS. Results: All cases present a high ECS (above the norm), so a correlation emerges between the disease and the patient-environment relationship. An indication of morbidity is related to ECS levels. Smoker and ex-smoker patients differ from non-smoker in oncological histotypes independently from BF levels, and the ECS values of smoker are higher due to the heavy WR-PSoc factors. Conclusions: The examined patients present a high ECS, so, the distorted human-environment relationship is also accompanied by severe illnesses. Anamnesis’ extension to environmental parameters is to be suggested, also as a prevention factor.