TY - JOUR
T1 - Controversies in drug allergy
T2 - Testing for delayed reactions
AU - Phillips, Elizabeth J.
AU - Bigliardi, Paul
AU - Bircher, Andreas J.
AU - Broyles, Ana
AU - Chang, Yoon Seok
AU - Chung, Wen Hung
AU - Lehloenya, Rannakoe
AU - Mockenhaupt, Maja
AU - Peter, Jonny
AU - Pirmohamed, Munir
AU - Roujeau, Jean Claude
AU - Shear, Neil H.
AU - Tanno, Luciana Kase
AU - Trubiano, Jason
AU - Valluzzi, Rocco
AU - Barbaud, Annick
N1 - Publisher Copyright:
© 2018 American Academy of Allergy, Asthma & Immunology
PY - 2019/1
Y1 - 2019/1
N2 - Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell–mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
AB - Controversies exist with regard to in vivo approaches to delayed immunologically mediated adverse drug reactions, such as exanthem (maculopapular eruption), drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome/toxic epidermal necrolysis, and fixed drug eruptions. In particular, widespread differences exist between regions and practice on the availability and use of intradermal and patch testing, the standard drug concentrations used, the use of additional drugs in intradermal and patch testing to help determine cross-reactivity, the timing of testing in relation to the occurrence of the adverse drug reaction, the use of testing in specific phenotypes, and the use of oral challenge in conjunction with delayed intradermal and patch testing to ascertain drug tolerance. It was noted that there have been advances in the science of delayed T cell–mediated reactions that have shed light on immunopathogenesis and provided a mechanism of preprescription screening in the case of HLA-B*57:01 and abacavir hypersensitivity and HLA-B*15:02 and carbamazepine Stevens-Johnson syndrome/toxic epidermal necrolysis in Southeast Asian subjects. Future directions should include the collaboration of large international networks to develop and standardize in vivo diagnostic approaches, such as skin testing and patch testing, combined with ex vivo and in vitro laboratory approaches.
KW - Delayed
KW - HLA
KW - Stevens-Johnson syndrome/toxic epidermal necrolysis
KW - acute generalized exanthematous pustulosis
KW - drug reaction with eosinophilia and systemic symptoms
KW - fixed drug eruption
KW - intradermal
KW - oral challenge
KW - patch
KW - prick
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U2 - 10.1016/j.jaci.2018.10.030
DO - 10.1016/j.jaci.2018.10.030
M3 - Review article
C2 - 30573342
AN - SCOPUS:85058976506
SN - 0091-6749
VL - 143
SP - 66
EP - 73
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 1
ER -