Vitamins are heterogeneous but essential biochemical substances which human body requires for its wellness. However, human organism cannot producevitamins, which need to be assimilated through the diet. Alternatively, their deficiency may induce severe diseases like rickets, pellagra or scurvy which can be disabling or lethal even. For that reason, every vitamin has been identified and chemically obtained for pharmaceutical and industrial purposes allowing their use like medication or food fortification. However, like any other drug, besides toxic reactions, i.e. hypervitaminosis, vitamins may induce hypersensitivity reactions, like contact dermatitis or anaphylaxis, especially in their synthetic form and according to their use. Given their importance for the organism the avoidance strategy is not possible with vitamins, which needed to be taken by the patient, despite his/her sensitization. So it is important to understand what approach should be used when a patient has a hypersensitivity to a vitamin.- Previously, in 1982, only Bundgaard and De Weck included a whole chapter on hypersensitivity to vitamins in their book “Allergic reactions to drugs” (Springer-Verlag- New York) and tried to investigate that issue. In the meanwhile, 39 years later, new case reports and studies have been published in literature, giving new indications and suggestions about the management of vitamins hypersensitivity. So, the effort of this book has been to collect most of the case reports from English literature mainly, thanks to a netsurfing research on Pubmed and Google Scholar and try to illustrate in an organic and systematic way, the mechanisms of vitamin sensitization, as understood or postulated by clinicians and researchers who have treated a vitamin sensitive patients “on the field”, with a focus on the clinical aspects, the diagnostic approach and the therapeutic managements, trying to highlight much more a minor topic of drug hypersensitivity. A specific chapter is dedicated to each vitamin and, after a short introduction concerning the biological activity, its use, a sketch on its metabolism and potential chemical derivatives are illustrated, but the most interesting part is represented by the experiences from the different authors and related discussions of their case reports or studies with an accurate description of the previous management strategies, showing, for instance, the desensitization protocols used by the different authors, the concentrations for the diagnostic skin tests or the challenge tests recommended, thus illustrating the possible options to the clinicians. The author limited to do some considerations of his on the basis of the vitamins metabolism, the comprehensive literature data and his clinical experience with drug allergy. Anyway, he considers also that, not always vitamins in their synthetic form are the true responsible for an allergic reaction. Sometimes, even excipients contained in vitamin pharmaceutical formulations s may induce hypersensitivity, while that issue surely does not occurs with the natural vitamins from foodstuffs. Of course, being the author an immunoallergist, his approach is influenced by his clinical and cultural background. Luckily, vitamin hypersensitivity is not so common as antibiotics allergy, but probably it is also undervalued, poorly diagnosed and certainly described anecdotally. For that reason, author tried to describe slenderly and pragmatically to summarize the actual knowledges and clinical experiences, with the hope that the book may be helpful for allergists, pediatrics, dermatologists, nutritionists, clinical pharmacologists and pharmacists too, thus any clinician may find some practical indications to manage a patient with hypersensitivity to vitamins.
About the Editor
Gianfranco Calogiuri is born in Lecce (Italy) on March, 5th 1961. He was graduated in Medicine in November 1988 at the Chieti University “Gabriele D’Annunzio” (Italy) and in November 1992 and he obtained the Board Certificate as Specialist in Allergy and Clinical Immunology at the Bari University “Aldo Moro” attending the Department of Allergy and Clinical Immunology directed by Professor Alfredo Tursi. In 1994 he took a master on Pediatric Allergy and Immunology at the Pediatric Department of Bari University, then he was assigned as medical assistant in different hospitals of the Azienda Sanitaria Lecce at First Aid Center firstly, then, in Internal Medicine, Infectious Diseases, Dermatology, Hematology, Clinical Pathology and Neurology. In 2005 he has been hired at the Pneumology Hospital in San Cesario di Lecce and in 2011 he has worked as consultant in Allergy and Pneumology at the Asthma Center of the Hospital “Ninetto Melli” in San Pietro Vernotico (Brindisi-Italy) up to 2016. In 2012 he obtained his PhD in Immunology and Infectous Diseases at the Bari University with a thesis on the immunological status of the tracheotomy patients.
From 2016 up to 2020 he worked in the Department of Pneumology and Allergy at the Gallipoli “Sacro Cuore” Hospital (40 km far from Lecce). For the needing of well-trained doctors because of the COVID 19 pandemic, at the beginning of 2020 he was temporarily assigned at the Pneumology Department of Civil Hospital Vito Fazzi in Lecce. He is a member of European Academy of Allergy and Clinical Immunology (EAACI) from 2003 and a member of ENDA (European Network for Drug Allergy). He has published more than 70 articles on Italian and international medical journals as author and co-author and a books contributions. He also collaborates with the Department of Allergy and Clinical Immunology at Bari University to investigate the path mechanisms of drug allergy, either IgE-mediated or T-cell mediated, diagnosis, management, prevention and therapy. In 2003 he got married with his beloved wife Maria Rita and they have a son, Pier Francesco.
Keywords: heterogenous bioactive substances, Allergy, Cosmetics, Fat-Soluble Vitamins, Food Excipients, Food Fortification, Vitamin Deficiency, Hypersensitivity, Dexpanthenol, Immediate-type Reaction, Pantothenate, Pantothenic Acid, Urticaria, Retinoids, Retinol, DRESS Syndrome.
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